Visual scoring of osteoporosis on low-dose CT in lung cancer screening population

Yeqing Zhu, Rowena Yip, Artit C. Jirapatnakul, Mingqian Huang, Qiang Cai, Etan Dayan, Li Liu, Anthony P. Reeves, Claudia I. Henschke, David F. Yankelevitz

Research output: Contribution to journalArticlepeer-review


Objectives: The risk factors for lung cancer screening eligibility, age as well as smoking history, are also present for osteoporosis. This study aims to develop a visual scoring system to identify osteoporosis that can be applied to low-dose CT scans obtained for lung cancer screening. Materials and methods: We retrospectively reviewed 1000 prospectively enrolled participants in the lung cancer screening program at the Mount Sinai Hospital. Optimal window width and level settings for the visual assessment were chosen based on a previously described approach. Visual scoring of osteoporosis and automated measurement using dedicated software were compared. Inter-reader agreement was conducted using six readers with different levels of experience who independently visually assessed 30 CT scans. Results: Based on previously validated formulas for choosing window and level settings, we chose osteoporosis settings of Width = 230 and Level = 80. Of the 1000 participants, automated measurement was successfully performed on 774 (77.4 %). Among these, 138 (17.8 %) had osteoporosis. There was a significant correlation between the automated measurement and the visual score categories for osteoporosis (Kendall's Tau = −0.64, p < 0.0001; Spearman's rho = −0.77, p < 0.0001). We also found substantial to excellent inter-reader agreement on the osteoporosis classification among the 6 radiologists (Fleiss κ = 0.91). Conclusions: Our study shows that a simple approach of applying specific window width and level settings to already reconstructed sagittal images obtained in the context of low-dose CT screening for lung cancer is highly feasible and useful in identifying osteoporosis.

Original languageEnglish
Article number110115
JournalClinical Imaging
StatePublished - May 2024


  • Low-dose CT
  • Lung cancer screening
  • Osteoporosis
  • Visual scoring


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