Deep Learning in CT Images: Automated Pulmonary Nodule Detection for Subsequent Management Using Convolutional Neural Network

Purpose: The purpose of this study is to compare the detection performance of the 3-dimensional convolutional neural network (3D CNN)-based computer-aided detection (CAD) models with radiologists of different levels of experience in detecting pulmonary nodules on thin-section computed tomography (CT). Patients and Methods: We retrospectively reviewed 1109 consecutive patients who under-went follow-up thin-section CT at our institution. The 3D CNN model for nodule detection was re-trained and complemented by expert augmentation. The annotations of a consensus panel consisting of two expert radiologists determined the ground truth. The detection performance of the re-trained CAD model and three other radiologists at different levels of experience were tested using a free-response receiver operating characteristic (FROC) analysis in the test group. Results: The detection performance of the re-trained CAD model was significantly better than that of the pretrained network (sensitivity: 93.09% vs 38.44%). The re-trained CAD model had a significantly better detection performance than radiologists (average sensitivity: 93.09% vs 50.22%), without significantly increasing the number of false positives per scan (1.64 vs 0.68). In the training set, 922 nodules less than 3 mm in size in 211 patients at high risk were recommended for follow-up CT according to the Fleischner Society Guidelines. Fifteen of 101 solid nodules were confirmed to be lung cancer. Conclusion: The re-trained 3D CNN-based CAD model, complemented by expert augmentation, was an accurate and efficient tool in identifying incidental pulmonary nodules for subsequent management.