Correlation of Algorithmic and Visual Assessment of Lesion Detection in Clinical Images

Rationale and Objectives: Clinically-relevant quantitative measures of task-based image quality play key roles in effective optimization of medical imaging systems. Conventional phantom-based measures do not adequately reflect the real-world image quality of clinical Computed Tomography (CT) series which is most relevant for diagnostic decision-making. The assessment of detectability index which incorporates measurements of essential image quality metrics on patient CT images can overcome this limitation. Our current investigation extends and validates the technique on standard-of-care clinical cases. Materials and Methods: We obtained a clinical CT image dataset from an Institutional Review Board-approved prospective study on colorectal adenocarcinoma patients for detecting hepatic metastasis. For this study, both perceptual image quality and lesion detection performance of same-patient CT image series with standard and low dose acquisitions in the same breath hold and four processing algorithms applied to each acquisition were assessed and ranked by expert radiologists. The clinical CT image dataset was processed using the previously validated method to estimate a detectability index for each known lesion size in the size distribution of hepatic lesions relevant for the imaging task and for each slice of a CT series. We then combined these lesion-size-specific and slice-specific detectability indexes with the size distribution of hepatic lesions relevant for the imaging task to compute an effective detectability index for a clinical CT imaging condition of a patient. The assessed effective detectability indexes were used to rank task-based image quality of different imaging conditions on the same patient for all patients. We compared the assessments to those by expert radiologists in the prospective study in terms of rank order agreement between the rankings of algorithmic and visual assessment of lesion detection and perceptual quality. Results: Our investigation indicated that algorithmic assessment of lesion detection and perceptual quality can predict observer assessment for detecting hepatic metastasis. The algorithmic and visual assessment of lesion detection and perceptual quality are strongly correlated using both the Kendall's Tau and Spearman's Rho methods (perfect agreement has value 1): for assessment of lesion detection, 95% of the patients have rank correlation coefficients values exceeding 0.87 and 0.94, respectively, and for assessment of perceptual quality, 0.85 and 0.94, respectively. Conclusion: This study used algorithmic detectability index to assess task-based image equality for detecting hepatic lesions and validated it against observer rankings on standard-of-care clinical CT cases. Our study indicates that detectability index provides a robust reflection of overall image quality for detecting hepatic lesions under clinical CT imaging conditions. This demonstrates the concept of utilizing the measure to quantitatively assess the quality of the information content that different imaging conditions can provide for the same clinical imaging task, which enables targeted optimization of clinical CT systems to minimize clinical and patient risks.