Tomosynthesis (digital tomography) has recently appeared as an interesting alternative to radiography and computed tomography in the evaluation of the lungs in cystic fibrosis (CF), since pulmonary CF changes are better visualized with tomosynthesis than with radiography [1] (Figs. 1-4, patient 1, and Figs. 5-7, patient 2) and the radiation dose is low. The purpose of the study was to design and validate a scoring system for tomosynthesis in pulmonary cystic fibrosis.

The tomosynthesis scoring system A scoring system dedicated for tomosynthesis in pulmonary cystic fibrosis (CF) was created, based on established CF scoring systems for radiography and computed tomography. The scoring system was designed to evaluate the whole spectrum of mild to severe CF pulmonary disease.The subscores of five well-recognized pathologic changes in CF lung disease (overinflation, bronchial wall thickening, parenchymal lesions, bronchiectases and mucus plugging) were defined in a scoring form illustrated with reference images, and the lesions were scored for severity and extent.The total...

Observer agreements for the tomosynthesis score were almost perfect for the total score with square-weighted kappa >0.90, and generally substantial to almost perfect for subscores [3]. Observer agreements for the total score for the Brasfield score were also almost perfect (square-weighted kappa 0.80, 0.81 and 0.85). Correlation between the tomosynthesis score and the Brasfield score was good for the three observers (Kendall’s rank correlation tau 0.68, 0.77 and 0.78). The total disease severity scores were generally higher for tomosynthesis than for radiography in percentage of...

The tomosynthesis score had high observer agreements for the total score and subscores and correlates well with the Brasfield score for radiography. Since tomosynthesis is more sensitive to pulmonary CF changes than radiography, in particular bronchiectases and mucus plugging, the total disease severity scores were generally higher for tomosynthesis than for radiography in percentage of the maximum score. Tomosynthesis is performed on the same X-ray system as chest radiography (adding only about one minute to the normal examination time) and results approximately in a 2-...

1. Vult von Steyern K, Björkman-Burtscher I, Geijer M (2011) Tomosynthesis in pulmonary cystic fibrosis with comparison to radiography and computed tomography: a pictorial review. Insights into Imaging DOI 10.1007/s13244-011-0137-9. 2. Brasfield D, Hicks G, Soong S, et al. (1979) The chest roentgenogram in cystic fibrosis: a new scoring system. Pediatrics 63:24-29. 3. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159-174. 4. Svensson E, Holm S (1994) Separation of systematic and random differences in ordinal rating scales. Stat...

Kristina Vult von Steyern, M.D. Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, Sweden. E-mail: [email protected]