Our findings will help reveal variations in the unidimensional, bidimensional, and volumetric measurements on modern CT scans and thus be valuable in detecting biologically relevant tumor changes in the assessment of therapy response in non–small cell lung cancer.


To evaluate the variability of tumor unidimensional, bidimensional, and volumetric measurements on same-day repeat computed tomographic (CT) scans in patients with non–small cell lung cancer.

Materials and Methods

This HIPAA–compliant study was approved by the institutional review board, with informed patient consent. Thirty-two patients with non–small cell lung cancer, each of whom underwent two CT scans of the chest within 15 minutes by using the same imaging protocol, were included in this study. Three radiologists independently measured the two greatest diameters of each lesion on both scans and, during another session, measured the same tumors on the first scan. In a separate analysis, computer software was applied to assist in the calculation of the two greatest diameters and the volume of each lesion on both scans. Concordance correlation coefficients (CCCs) and Bland-Altman plots were used to assess the agreements between the measurements of the two repeat scans (reproducibility) and between the two repeat readings of the same scan (repeatability).


The reproducibility and repeatability of the three radiologists' measurements were high (all CCCs, ≥0.96). The reproducibility of the computer-aided measurements was even higher (all CCCs, 1.00). The 95% limits of agreements for the computer-aided unidimensional, bidimensional, and volumetric measurements on two repeat scans were (−7.3%, 6.2%), (−17.6%, 19.8%), and (−12.1%, 13.4%), respectively.


Chest CT scans are well reproducible. Changes in unidimensional lesion size of 8% or greater exceed the measurement variability of the computer method and can be considered significant when estimating the outcome of therapy in a patient.

© RSNA, 2009


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Article History

Received September 5, 2008; revision requested October 29; revision received January 13, 2009; accepted February 13; final version accepted March 3.
Published in print: July 2009