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A new computer-based decision-support system for the interpretation of bone scans

Sadik, Maya; Jakobsson, Davidb; Olofsson, Fredrikb; Ohlsson, Mattiasb c; Suurkula, Madisa; Edenbrandt, Larsa b

Nuclear Medicine Communications: May 2006 - Volume 27 - Issue 5 - p 417-423

Objective To develop a completely automated method, based on image processing techniques and artificial neural networks, for the interpretation of bone scans regarding the presence or absence of metastases.

Methods A total of 200 patients, all of whom had the diagnosis of breast or prostate cancer and had undergone bone scintigraphy, were studied retrospectively. Whole-body images, anterior and posterior, were obtained after injection of 99mTc-methylene diphosphonate. The study material was randomly divided into a training group and a test group, with 100 patients in each group. The training group was used in the process of developing the image analysis techniques and to train the artificial neural networks. The test group was used to evaluate the automated method. The image processing techniques included algorithms for segmentation of the head, chest, spine, pelvis and bladder, automatic thresholding and detection of hot spots. Fourteen features from each examination were used as input to artificial neural networks trained to classify the images. The interpretations by an experienced physician were used as the ‘gold standard’.

Results The automated method correctly identified 28 of the 31 patients with metastases in the test group, i.e., a sensitivity of 90%. A false positive classification of metastases was made in 18 of the 69 patients not classified as having metastases by the experienced physician, resulting in a specificity of 74%.

Conclusion A completely automated method can be used to detect metastases in bone scans. Future developments in this field may lead to clinically valuable decision-support tools.

aDepartments of Clinical Physiology, Sahlgrenska University Hospital, Göteborg

bDepartment of Clinical Physiology, Malmö University Hospital

cDepartment of Theoretical Physics, Lund University, Sweden

Correspondence to May Sadik, Department of Clinical Physiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.

Tel: +0046 313 42141 6; fax: +0046 314 11735;


This study was supported by grants from the Swedish Medical Research Council.

Received 4 January 2006 Revised 27 January 2006 Accepted 27 January 2006

© 2006 Lippincott Williams & Wilkins, Inc.