Missed Lung Lesions: Side by Side Comparison of Chest Radiography with MDCT

Missed lung lesions are one of the most frequent causes of malpractice issues [1, 2, 3, 4]. Chest radiography plays an important role in the detection and management of patients with lung cancer, chronic airways disease, pneumonia, and interstitial lung disease. Among all diagnostic tests, chest radiography is essential for confirming or excluding the diagnosis of most chest diseases. However, numerous lesions of a wide variety of disease processes affecting the thorax may be missed on a chest radiograph. For example, the frequency of missed lung carcinoma on chest radiographs can vary from 12 to 90%, depending on study design [5]. Despite the lack of convincing evidence that screening for lung cancer with the chest radiograph improves mortality, chest radiography is still requested for this purpose [6, 7] The chest radiograph will also help in narrowing a differential diagnosis and in determining additional diagnostic measures, in addition to being of use during follow-up. The diagnostic utility of the radiograph will be maximized by integrating the radiological findings with the clinical features of the individual patient [8]. In this chapter, we review the more important radiological principles regarding missed lung lesions in a variety of common chest diseases, with a focus on how the correlation of missed lung lesions with subsequent multi-detector computed tomography (MDCT) can help improve interpretation of the plain chest radiograph.