U-Net-based Lung Thickness Map for Pixel-level Lung Volume Estimation of Chest X-rays

Purpose: We aimed to estimate the total lung volume (TLV) from real and synthetic frontal X-ray radiographs on a pixel level using lung thickness maps generated by a U-Net. Methods: 5,959 thorax X-ray computed tomography (CT) scans were retrieved from two publicly available datasets of the lung nodule analysis 2016 (n=656) and the RSNA pulmonary embolism detection challenge 2020 (n=5,303). Additionally, thorax CT scans from 72 subjects (33 healthy: 20 men, mean age [range] = 62.4 [34, 80]; 39 suffering from chronic obstructive pulmonary disease: 25 men, mean age [range] = 69.0 [47, 91]) were retrospectively selected (10.2018-12.2019) from our in-house dataset such that for each subject, a frontal chest X-ray radiograph no older than seven days was available. All CT scans and their corresponding lung segmentation were forward projected using a simulated X-ray spectrum to generate synthetic radiographs and lung thickness maps, respectively. A U-Net model was trained and tested on synthetic radiographs from the public datasets to predict lung thickness maps and consequently estimate TLV. Model performance was further assessed by evaluating the TLV estimations for the in-house synthetic and real radiograph pairs using Pearson correlation coefficient (r) and significance testing. Results: Strong correlations were measured between the predicted and CT-derived ground truth TLV values for test data from synthetic ($n_{Public}$=1,191, r=0.987, P < 0.001; $n_{In-house}$=72, r=0.973, P < 0.001) and real radiographs (n=72, r=0.908, P < 0.001). Conclusion: TLV from U-Net-generated pixel-level lung thickness maps were successfully estimated for synthetic and real radiographs.