We present the first investigation of propagation-based phase-contrast chest X-ray (CXR) imaging. Conventional and phase-contrast CXR images of virtual patients were generated by applying wave-propagation simulations to XCAT virtual chest phantoms. We then performed a reader study with clinical radiologists to investigate the potential clinical impact of phase-contrast CXR. No significant improvement in lesion (6-20 mm) detection rate was found, however, phase-contrast CXR could visualize small airways that are invisible in conventional CXR. This could have clinical significance for diagnosing diseases presenting a thickening of airway walls, such as in asthma and early-stage chronic obstructive pulmonary disease (COPD).
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