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AI Can Help Radiologists Avoid Missed Lung Cancer on Chest X-Ray Images
By MedImaging International staff writers Posted on 20 Apr 2023
Image: A new study has found some common features of missed lung cancer cases on chest X-ray images (Photo courtesy of Freepik)
Chest radiography is the most frequently performed first-line imaging examination, often used for routine health checkups, preoperative evaluations, and lung cancer screenings in primary healthcare settings worldwide. However, false-negative or misleading chest radiography results are common, and unexpected abnormalities like lung cancer may be overlooked. Missing lung cancer can result in the disease progressing from an early-stage, potentially curable state to advanced-stage lung cancer, leading to poor patient outcomes. Now, a recent analysis has identified common features of missed lung cancer cases on chest X-ray images, suggesting that computer-aided detection systems or artificial intelligence could assist radiologists in avoiding such errors.
Researchers at Ramathibodi Hospital (Bangkok, Thailand) analyzed chest X-rays from 75 patients at a single institution, where initial signs of lung cancer were overlooked. They found common features of missed lung cancer cases, including the tumor's location, density, and any superimposed anatomical structures. According to the researchers, radiologists can prevent such errors by comparing the chest radiograph being read with previous examples, focusing on common blind spots, avoiding misidentification of lesions as normal structures, and using computer-aided detection systems or artificial intelligence.
The study retrospectively reviewed chest X-rays of 95 patients taken at least six months before a lung cancer diagnosis. The final sample consisted of 75 patients, with an even gender distribution and an average age of nearly 65 years. The median missed lung cancer size was approximately 16 mm. Most cases (75%) occurred in the outer two-thirds of the lung, followed by 68% in the middle/lower zones and 55% in the left lung. Common features included anatomical superimposition (88% of cases), density lower than the aortic knob (85%), partly or poorly defined margin (77%), irregular or spiculated border (61%), and rounded or oval shape (57%). Almost 47% of the missed cases had stage 3 or 4 lung cancer, and 41% of patients died.
The findings indicate that certain radiographic features of missed lung cancer, such as density, location, and superimposed anatomical structures, identified in the first positive chest radiograph were linked to advanced-stage lung cancer diagnosis and higher 3-year all-cause mortality. Delayed detection of missed lung cancer with such radiographic features on chest radiography may lead to worse outcomes. Hence, radiologists should pay special attention to and promptly report equivocal or borderline lesions in the upper zone or inner one-third of the lung, those with density equal to or greater than the aortic knob, or those superimposed by midline structures, pulmonary vessels, and ribs found incidentally on chest radiographs. The researchers hope that these findings will help radiologists avoid errors that can result in poor patient outcomes and death. Furthermore, computer-aided detection systems or artificial intelligence could improve radiologist performance and help detect smaller tumors, suggested the researchers.
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(39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 186
(196.93374633789): SELECT show_live FROM jos_com_show_setting LIMIT 187
(41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 188
(166.89300537109): SELECT show_live FROM jos_com_show_setting LIMIT 189
(36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 190
(452.04162597656): SELECT fid FROM jos_deeppockets
WHERE cat=10
AND id=294796905
AND (type='deeppockets_item' OR type='deeppockets_item_link')
AND published='1'
LIMIT 191
(35.04753112793): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796905 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 192
(135.89859008789): SELECT id,name,title
FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1
AND id != 294743300
AND id != 294743301
AND id != 294743302
AND id != 294743303
AND id != 294743304
AND id != 294743305
AND id != 294743306
AND id != 294743307
AND id != 294743308
AND id != 294743309
AND id != 294743310
AND metakey != 'aacc'
ORDER BY `ordering`93
(51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 194
(31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 195
(!!!!! 1036.8824005127): SELECT show_live FROM jos_com_show_setting LIMIT 196
(38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 197
(38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 198
(29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 199
(30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1100
(38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1101
(30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1102
(36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1103
(36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1104
(36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1105
(36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1106
(40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1107
(90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1108
(!!!!! 1055.9558868408): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1109
(211.00044250488): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294796905
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1110
(473.0224609375): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294796905
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1111
(972.03254699707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1112
(141.85905456543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1113
(136.13700866699): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.id=294796905
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1114
(!!!!! 1393.7950134277): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.id=294796905
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1115
(744.10438537598): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp
LEFT JOIN jos_experts as ex
ON ex.id = dp.author
LEFT JOIN jos_deeppockets as dp2
ON dp2.id = dp.fid
WHERE dp.author != 0
AND dp.cat = 10
AND dp.published = 1
AND (
(dp.fid = 294743300)
OR (dp.fid = 294743301)
OR (dp.fid = 294743302)
OR (dp.fid = 294743303)
OR (dp.fid = 294743304)
OR (dp.fid = 294743305)
OR (dp.fid = 294743306)
OR (dp.fid = 294743307)
OR (dp.fid = 294743308)
OR (dp.fid = 294743309)
OR (dp.fid = 294743310)
)
ORDER BY RAND()
LIMIT 1116
(511.88468933105): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp
LEFT JOIN jos_experts as ex
ON ex.id = dp.author
LEFT JOIN jos_deeppockets as dp2
ON dp2.id = dp.fid
WHERE dp.author != 0
AND dp.cat = 10
AND dp.published = 1
AND (
(dp.fid = 294743300)
OR (dp.fid = 294743301)
OR (dp.fid = 294743302)
OR (dp.fid = 294743303)
OR (dp.fid = 294743304)
OR (dp.fid = 294743305)
OR (dp.fid = 294743306)
OR (dp.fid = 294743307)
OR (dp.fid = 294743308)
OR (dp.fid = 294743309)
OR (dp.fid = 294743310)
)
ORDER BY RAND()
LIMIT 1117
(161.17095947266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1118
(67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1119
(66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1120
(44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1121
(59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1122
(50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1123
(70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1124
(46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1125
(257.01522827148): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`126
(!!!!! 21893.02444458): SELECT
*
FROM
jos_deeppockets
WHERE
jos_deeppockets.cat = 10
AND
jos_deeppockets.type = 'deeppockets_item'
AND
jos_deeppockets.published = 1
AND
jos_deeppockets.created + INTERVAL 14 DAY >= NOW()
ORDER BY
jos_deeppockets.hits DESC
LIMIT
7127
(667.09518432617): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294796905 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796905 AND type='deeppockets_item' AND published='1' LIMIT 1128
(62.942504882812): (
SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.video != ''
AND
dp.video_source != ''
AND
dp.cat = 10
AND
dp.published = 1
AND
dp.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
UNION
(
SELECT
dpa.id,
dpa.name,
dpa.title,
dpa.video,
dpa.video_source,
dpa.created
FROM
jos_deeppockets_archive AS dpa
WHERE
dpa.video != ''
AND
dpa.video_source != ''
AND
dpa.cat = 10
AND
dpa.published = 1
AND
dpa.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
ORDER BY
created DESC
LIMIT
3129
(37.908554077148): (
SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.video != ''
AND
dp.video_source != ''
AND
dp.cat = 10
AND
dp.published = 1
AND
dp.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
UNION
(
SELECT
dpa.id,
dpa.name,
dpa.title,
dpa.video,
dpa.video_source,
dpa.created
FROM
jos_deeppockets_archive AS dpa
WHERE
dpa.video != ''
AND
dpa.video_source != ''
AND
dpa.cat = 10
AND
dpa.published = 1
AND
dpa.type != 'deeppockets_item_link'
ORDER BY
created DESC
LIMIT
3
)
ORDER BY
created DESC
LIMIT
3130
(34.809112548828): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803337
LIMIT 1131
(29.087066650391): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803337
LIMIT 1132
(38.14697265625): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803276
LIMIT 1133
(27.179718017578): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294803276
LIMIT 1134
(26.941299438477): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets_archive AS dp
WHERE
dp.id = 294803276
LIMIT 1135
(27.894973754883): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets_archive AS dp
WHERE
dp.id = 294803276
LIMIT 1136
(29.087066650391): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294802958
LIMIT 1137
(26.941299438477): SELECT
dp.id,
dp.name,
dp.title,
dp.video,
dp.video_source,
dp.created
FROM
jos_deeppockets AS dp
WHERE
dp.id = 294802958
LIMIT 1138
(339.98489379883): SELECT *
FROM jos_deeppockets
WHERE 1=1
AND id=294796905
AND (type='deeppockets_item' OR type='deeppockets_item_link')
AND published='1'
LIMIT 1139
(267.98248291016): SELECT *
FROM jos_deeppockets_archive
WHERE 1=1
AND id=294796905
AND (type='deeppockets_item' OR type='deeppockets_item_link')
AND published='1'
LIMIT 1140
(36.001205444336): SELECT name FROM jos_deeppockets WHERE id=211141
(29.087066650391): SELECT name FROM jos_deeppockets WHERE id=211142
(537.87231445312): SELECT *,
DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up,
DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down
FROM jos_events
WHERE state=1
AND publish_up > NOW()
and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110)
ORDER BY publish_up ASC LIMIT 3143
(494.95697021484): SELECT *,
DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up,
DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down
FROM jos_events
WHERE state=1
AND publish_up > NOW()
and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110)
ORDER BY publish_up ASC LIMIT 3144
(62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1145
(47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1146
(!!!!! 8330.8219909668): TRUNCATE TABLE jos_trademed_module147
(148.05793762207): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294796905
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1148
(74.863433837891): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp
LEFT JOIN jos_experts as exp
ON exp.id = dp.author
LEFT JOIN jos_deeppockets as ch
ON dp.fid = ch.id
WHERE 1=1
AND dp.cat=10
AND dp.id=294796905
AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
AND dp.published='1' LIMIT 1149
(850.91590881348): SELECT *
FROM jos_deeppockets
WHERE 1=1
AND id=294796905
AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1150
(80.82389831543): SELECT *
FROM jos_deeppockets
WHERE 1=1
AND id=294796905
AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1151
(59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1152
(42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1153
(!!!!! 1389.0266418457): SELECT jos_item.*
FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id
WHERE 1=1
AND (jos_item.imgMini<>'')
AND jos_item.type='L'
AND jos_item.numberID= (
SELECT jos_number.id
FROM jos_number
WHERE jos_number.journalID IN (10)
and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P')
ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC
LIMIT 0,1
)
ORDER BY RAND() DESC LIMIT 6154
(70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1155
(44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1156
(40.054321289062): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294796905 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294796905 AND type='deeppockets_item' AND published='1' LIMIT 1157
(34.093856811523): select distinct links.*
from jos_textlinks links
join jos_textlinks_placement placement on links.id=placement.link_id
where journal_id=(10) and (channel_id=211 or channel_id is null)158
(31.948089599609): select distinct links.*
from jos_textlinks links
join jos_textlinks_placement placement on links.id=placement.link_id
where journal_id=(10) and (channel_id=211 or channel_id is null)159
(34.093856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1160
(66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1161
(42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294796905 AND published='1'
union
SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294796905 AND published='1'
LIMIT 1162
(57.93571472168): select jos_twitters.link from jos_twitters where cat=10163
(44.107437133789): select jos_facebook.link from jos_facebook where cat=10164
(42.915344238281): select jos_google_plus.link from jos_google_plus where cat=10165
(51.975250244141): select jos_linkedin.link from jos_linkedin where cat=10166
(283.00285339355): update jos_bannersmanager_banner
set impmade=impmade+1
where id in(14615,14202,14203)167
(!!!!! 1173.0194091797): insert into jos_banners_delta values (14615,'2025-08-25 13:19:27','216.73.216.114','view'),(14202,'2025-08-25 13:19:27','216.73.216.114','view'),(14203,'2025-08-25 13:19:27','216.73.216.114','view')
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