Dynamic-Ventilatory Digital Radiography in Air Flow Limitation: A Change in Lung Area Reflects Air Trapping

Ohkura, Noriyuki; Kondo, Kazuo; Watanabe, Satoshi; Hara, Johsuke; Abo, Masahiro; Sone, Takashi; Kimura, Hideharu; Takata, Munehisa; Tamura, Masaya; Matsumoto, Isao; Nakade, Yusuke; Sanada, Shigeru; Tanaka, Rie

doi:10.1159/000506881

Cited by 25 publications

(40 citation statements)

References 25 publications

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“…DCR is now becoming available in a wide range of facilities and can be conducted as an additional examination to conventional chest radiography. Moreover, the high temporal and spatial resolution allows for the evaluation of the ventilation and perfusion components, as well as for providing information related to diaphragm motion 28 and changes in lung areas 29 at the same time during one labored breathing cycle. Patients are still irradiated for the examination; however, the total radiation dose is approximately double that of conventional chest radiography, and therefore, DCR is acceptable owing to the increased yield of information and to being a simple and rapid procedure of functional imaging.…”

Section: Discussionmentioning

confidence: 99%

Comparison of dynamic flat‐panel detector‐based chest radiography with nuclear medicine ventilation‐perfusion imaging for the evaluation of pulmonary function: A clinical validation study

et al. 2020

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Purpose: Dynamic chest radiography (DCR) is a flat-panel detector (FPD)-based functional lung imaging technique capable of measuring temporal changes in radiographic lung density due to ventilation and perfusion. The aim of this study was to determine the diagnostic performance of DCR in the evaluation of pulmonary function based on changes in radiographic lung density compared to nuclear medicine lung scans. Methods: This study included 53 patients with pulmonary disease who underwent DCR and nuclear medicine imaging at our institution. Dynamic chest radiography was conducted using a dynamic FPD system to obtain sequential chest radiographs during one breathing cycle. The maximum change in the average pixel value (Δ max) was measured, and the percentage ofΔ max in each lung region, calculated relative to the sum of all lung regions (Δ max %), was calculated for each factor (ventilation and perfusion). The Δ max % was compared with the accumulation of radioactive agents (radioactive agents%) on ventilation and perfusion scans in each lung and lung region using correlation coefficients and scatter plots. The ratio of ventilation to perfusion Δ max % was calculated and compared with nuclear medicine ventilation-perfusion (V/Q) findings in terms of sensitivity and specificity for V/Q mismatch in each lung region. Results: There was a high correlation between Δ max % and radioactive agents% for each lung (Ventilation: r = 0.81, perfusion: r = 0.87). However, correlation coefficients were lower (0.37 to 0.80) when comparing individual lung regions, with the upper lung regions showing the lowest correlation coefficients. The sensitivity and specificity of DCR for V/Q mismatch were 63.3% (19/30) and 60.1% (173/288), respectively. Motion artifacts occasionally increased Δ max %, resulting in false negatives. Conclusions: Ventilation and perfusion Δ max % correlated reasonably with radioactive agents% on ventilation and perfusion scans. Although the regional correlations were lower and the detection performance for V/Q mismatch was not enough for clinical use at the moment, these results suggest the potential for DCR to be used as a functional imaging modality that can be performed without the use of radioactive contrast agents. Further technical improvement is required for the implementation of DCR-based V/Q studies.

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Section: Discussionmentioning

confidence: 99%

Comparison of dynamic flat‐panel detector‐based chest radiography with nuclear medicine ventilation‐perfusion imaging for the evaluation of pulmonary function: A clinical validation study

et al. 2020

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“…Since dynamic DR is a noninvasive evaluation and is easy to perform, even unstable patients can be repeatedly tested. Additionally, the sequential chest X-ray images provided by dynamic DR 9 during respiration make it easy for both operators and patients to understand the respiratory kinetics of the chest. Thus, this system can be expected to improve the patient's understanding of the disease and adherence to treatment in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…Dynamic-ventilatory DR was performed as previously reported. 9 Sequential chest radiography images were obtained during respiration by a dynamic FPD imaging device (Test Model; Konica Minolta, Inc., Tokyo, Japan) with an indirect-conversion FPD (PaxScan, 4343CB, Varex Imaging Corporation, Salt Lake City, UT, USA) and X-ray generator/tube capable of pulsed radiation (DHF-155H II/UH-6QC-07E, Hitachi, Ltd.). To be a reliable diagnostic tool, the device must produce very homogeneous and uniform X-ray pulses.…”

Section: Methodsmentioning

confidence: 99%

“… 8 We also have shown that the rate of change in the area of the lung in a slowly breathing patient from maximum inspiration to maximum expiration was associated with residual volume/total lung capacity (TLC) and predicted FEV 1 in patients with airflow limitations. 9 In that study, the lung area of a patient at maximum inspiration was strongly correlated with vital capacity (VC), functional residual capacity (FRC), and TLC. However, little is known about the role of dynamic-ventilatory DR in the classification of ventilatory disorders including COPD and ILD.…”

Section: Introductionmentioning

confidence: 94%

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Chest Dynamic-Ventilatory Digital Radiography in Chronic Obstructive or Restrictive Lung Disease

Ohkura¹,

Tanaka²,

Watanabe³

et al. 2021

COPD

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The aim of this study was to identify the relationships between parameters obtained from dynamic-ventilatory digital radiography (DR) and ventilatory disorders. Methods: This study comprised 273 participants with respiratory diseases who underwent spirometry and functional residual capacity measurements (104 with normal findings on spirometry as controls, 139 with an obstructive lung disorder, 30 with a restrictive lung disorder) were assessed by dynamic-ventilatory DR. Sequential chest radiography images of the patient's slow and maximum breathing were captured at 15 frames per second by a dynamic flat-panel imaging system. The system measured the following parameters: lung area at maximum inspiration divided by height (lung area_in/height), changes in tracheal diameter due to respiratory motions, rate of tracheal narrowing, diaphragmatic motion, and rate of change in lung area due to respiratory motion. Relationships between these parameters and ventilatory disorders were analyzed. Results: Lung area_in/height in patients with restrictive disorders showed significant decreases. Tracheal diameter change and tracheal narrowing rate in patients with obstructive disorders were significantly increased compared to both the control participants and patients with restrictive disorders. Patients with obstructive disorders and patients with restrictive disorders showed decreased diaphragmatic motion and lung area change rate. With the restrictive disorders as references, the area under the curve (AUC), sensitivity and specificity of lung area_in/height were 0.88, 0.77, and 0.88, respectively. With the obstructive disorders as references, the AUC, sensitivity and specificity of tracheal narrowing rate were 0.67, 0.53 and 0.81, respectively. Conclusion: Dynamic-ventilatory DR shows potential as a method for the detection and evaluation of ventilatory disorders in patients with respiratory diseases.

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“…Until date, DCR has been reported for image evaluation of chronic thromboembolic pulmonary hypertension, for the prediction of tumor from visceral pleura origin, correlation between changes in lung eld area and lung function tests, and the evaluation of intrathoracic tracheal narrowing in patients with COPD (25)(26)(27)(28). DCR can provide information not only in the supine position but also in a more physiological respiratory state of breathing, depending on the patient's position (standing or sitting).…”

Section: Discussionmentioning

confidence: 99%

Dynamic perfusion digital radiography for predicting pulmonary function after lung cancer resection

Hanaoka

Yoden

Hayashi

et al. 2021

Preprint

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Background: Accurate prediction of postoperative pulmonary function is important for ensuring the safety of patients undergoing radical resection for lung cancer. Dynamic perfusion digital radiography is an excellent and easy imaging method for detecting blood flow in the lung compared with the less convenient conventional lung perfusion scintigraphy. As such, the present study aimed to confirm whether dynamic perfusion digital radiography can be evaluated in comparison with pulmonary perfusion scintigraphy in predicting early postoperative pulmonary function and complications.Methods: Dynamic perfusion digital radiography and spirometry were performed before and 1 and 3 months after radical resection for lung cancer. Correlation coefficients between blood flow ratios calculated using dynamic perfusion digital radiography and pulmonary perfusion scintigraphy were then confirmed in the same cases. In all patients who underwent dynamic perfusion digital radiography, the correlation predicted values calculated from the blood flow ratio and measured values were examined. Furthermore, ppo%FEV1 or ppo%DLco values, which indicated the risk for perioperative complications, were examined.Results: A total of 52 participants who satisfied the inclusion criteria were analyzed. Blood flow ratios measured using pulmonary perfusion scintigraphy and dynamic perfusion digital radiography showed excellent correlation and acceptable predictive accuracy. Correlation coefficients between predicted FEV1 values obtained from dynamic perfusion digital radiography or pulmonary perfusion scintigraphy and actual measured values were similar. All patients who underwent dynamic perfusion digital radiography showed excellent correlation between predicted values and those measured using spirometry. A significant difference in ppo%DLco was observed for respiratory complications but not cardiovascular complications.Conclusions: Our study demonstrated that dynamic perfusion digital radiography can be a suitable alternative to pulmonary perfusion scintigraphy given its ability for predicting postoperative values and the risk for postoperative respiratory complications. Furthermore, it seemed to be an excellent modality because of its advantages, such as simplicity, low cost, and ease in obtaining in-depth respiratory functional information.Trial registration: Registered at UMIN on October 25, 2017. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000033957Registration number: UMIN000029716

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Dynamic-Ventilatory Digital Radiography in Air Flow Limitation: A Change in Lung Area Reflects Air Trapping

Cited by 25 publications

References 25 publications

Comparison of dynamic flat‐panel detector‐based chest radiography with nuclear medicine ventilation‐perfusion imaging for the evaluation of pulmonary function: A clinical validation study

Comparison of dynamic flat‐panel detector‐based chest radiography with nuclear medicine ventilation‐perfusion imaging for the evaluation of pulmonary function: A clinical validation study

Chest Dynamic-Ventilatory Digital Radiography in Chronic Obstructive or Restrictive Lung Disease

Dynamic perfusion digital radiography for predicting pulmonary function after lung cancer resection

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