E5088. Superior Airway Assessment Using Digital Tomosynthesis of Chest: A Head-to-Head Comparison With Conventional and Dual-Energy Radiography
  1. Lauren Hahn; University Hospitals
  2. Jennifer Sposato; University Hospitals
  3. Amit Gupta; University Hospitals
  4. Roy Raad; University Hospitals
  5. Kianoush Ansari Gilani; University Hospitals
  6. Robert Gilkeson; Case Western Reserve University; University Hospitals
  7. Jared Durieux; University Hospitals
The chest x-ray is the most commonly performed radiographic procedure; however, its limitations in spatial delineation and tissue differentiation make it less ideal for complex pathologies. Dual-energy subtraction radiography (DESR) aims to improve diagnostic accuracy by separating soft tissue from bone through high- and low-energy x-ray subtraction. Digital tomosynthesis (DTS) offers both superior spatial resolution and tissue delineation. DTS also utilizes a significantly lower radiation dose and cost compared to CT. Though DTS has been employed for improved detection of lung nodules, its application in airway evaluation remains unexplored. The purpose of this study is to assess DTS in the visualization of airway structures when compared to conventional radiography (CR) and DESR.

Materials and Methods:
A retrospective, multireader, blinded study was conducted with 30 cases (11 women, 19 men; median age 66.5; 17 cases with lung malignancies; eight cases with lung transplant history) that met the inclusion criteria of having chest CR, DESR, and DTS on the same day (total of 90 images). Three board-certified cardiothoracic radiologists evaluated 12 airway segments (upper and lower trachea; right and left mainstem bronchi; right and left lower lobar bronchi; right and left upper lobar bronchi; right and left upper segmental bronchi; right and left lower segmental bronchi) using a 5-point Likert scale (5 being best and 1 being worst visualization/diagnostic confidence).

DTS outperformed DESR and CR, achieving an average Likert score of 5 in 9/12 airway segments. DESR and CR achieved an average Likert score of 5 in three and four categories, respectively. DTS also had the lowest frequency of Likert scale scores of 1, 2, and 3 among the imaging types. Statistically, DTS was significantly superior in 10 out of the 12 evaluated structures (p < 0.01). Interreader agreement was calculated using Kappa values and proved to be superior in DTS versus CR and DESR. Adjusting for the probability of random rankings and misclassification, the overall estimated agreement was highest with DTS (0.78 ± 0.08).

This study establishes that DTS offers superior visualization of airway structures compared to both conventional and advanced dual-energy radiographic methods. This is further supported by the improved reliability in agreement and fewer misclassification errors among three board certified radiologists. DTS holds promise as a superior tool for long-term monitoring of patients with airway pathologies, significantly reducing radiation exposure and cost compared to CT.