Bone Suppression on Pediatric Chest Radiographs Via a Deep Learning-Based Cascade Model.

Background and objective: Bone suppression images (BSIs) of chest radiographs (CXRs) have been proven to improve diagnosis of pulmonary diseases. To acquire BSIs, dual-energy subtraction (DES) or a deep-learning-based model trained with DES-based BSIs have been used. However, neither technique could be applied to pediatric patients owing to the harmful effects of DES. In this study, we developed a novel method for bone suppression in pediatric CXRs. Methods: First, a model using digitally reconstructed radiographs (DRRs) of adults, which were used to generate pseudo-CXRs from computed tomography images, was developed by training a 2-channel contrastive-unpaired-image-translation network. Second, this model was applied to 129 pediatric DRRs to generate the paired training data of pseudo-pediatric CXRs. Finally, by training a U-Net with these paired data, a bone suppression model for pediatric CXRs was developed. Results: The evaluation metrics were peak signal to noise ratio, root mean absolute error and structural similarity index measure at soft-tissue and bone region of the lung. In addition, an expert radiologist scored the effectiveness of BSIs on a scale of 1-5. The obtained result of 3.31 +/- 0.48 indicates that the BSIs show homogeneous bone removal despite subtle residual bone shadow. Conclusion: Our method shows that the pixel intensity at soft-tissue regions was preserved, and bones were well subtracted; this can be useful for detecting early pulmonary disease in pediatric CXRs. (c) 2022 Elsevier B.V. All rights reserved.