A method is proposed to simulate nodules and diffuse infiltrates in chest radiographs. This allows creation of large annotated databases for training of both radiologists and computer aided diagnosis systems. Realistic nodules and diffuse infiltrates were generated from three-dimensional templates segmented from CT data. These templates are rescaled, rotated, projected and superimposed on a radiograph. This method was compared, in an observer study, to a previously published method that simulates pulmonary nodules as perfectly spherical objects. Results show that it is hard for human observers to distinguish real and simulated nodules when using templates (AUC-values do not significantly differ from .5, p > .05 for all observers). The method that produced spherical nodules performed slightly worse (AUC of one observer differs significantly from .5, p = .011). Simulation of diffuse infiltrates is challenging but also feasible (AUC = 0.67 for one observer).
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