Reproducibility of volumetric computed tomography of stable small pulmonary nodules with implications on estimated growth rate and optimal scan interval

Purpose: To use clinically measured reproducibility of volumetric CT (vCT) of lung nodules to estimate error in nodule growth rate in order to determine optimal scan interval for patient follow-up. Methods: We performed quantitative vCT on 89 stable non-calcified nodules and 49 calcified nodules measuring 3–13 mm diameter in 71 patients who underwent 3–9 repeat vCT studies for clinical evaluation of pulmonary nodules. Calculated volume standard deviation as a function of mean nodule volume was used to compute error in estimated growth rate. This error was then used to determine the optimal patient follow-up scan interval while fixing the false positive rate at 5%. Results: Linear regression of nodule volume standard deviation versus the mean nodule volume for stable non-calcified nodules yielded a slope of 0.057±0.002 (r2 = 0.79, p<0.001). For calcified stable nodules, the regression slope was 0.052±0.005 (r2 = 0.65, p = 0.03). Using this with the error propagation formula, the ...