Added Value of Bone Subtraction in Dual-energy Digital Radiography in the Detection of Pneumothorax: Impact of Reader Expertise and Medical Specialty

Rationale and Objectives: This study aimed to determine the value of dual-energy thoracic radiography in the diagnosis of pneumothorax considering the reader's experience. Materials and Methods: Forty patients with a suspected pneumothorax, imaged with dual-energy chest radiographs, were divided into two groups: those with pneumothorax as the final diagnosis (n = 19) and those without (n = 21). The images were analyzed by 36 readers (5 interns, 16 residents, 15 senior physicians) for the presence or absence of pneumothorax during three readout sessions at 2-week intervals: standard images alone (session 1), dual-energy images with bone subtraction alone (session 2), and a combination of the two (session 3). Results: The number of correct responses increased 13.3% between sessions 1 and 2 (P < .001) and 9.4% between sessions 1 and 3 (P < .001). The mean sensitivity for pneumothorax detection was higher in sessions 2 (82%) and 3 (79%) compared to session 1 (70%). There was no statistically significant difference in specificity between the sessions. The number of correct responses for small volume pneumothoraces was higher in sessions 2 (10.6 +/- 1.8) and 3 (10.1 +/- 2.0) than in session 1 (8.9 +/- 2.3), with a statistically significant difference between sessions 1 and 2 (P = .002) and between sessions 1 and 3 (P = .048). Conclusion: Bone subtracted dual-energy thoracic radiographs improve the detection sensitivity of pneumothorax, including in cases of small pneumothoraces, regardless of the reader's level or expertise.