Validity and reliability of fluoroscopy for digital radiography: a new way to evaluate diaphragmatic mobility

Leal, Bruna Estima; Gonçalves, Márcia Aparecida; Lisboa, Liseane Gonçalves; Linné, Larissa Martins Schmitz; Tavares, Michelle Gonçalves de Souza; Yamaguti, Wellington Pereira; Paulin, Elaine

doi:10.1186/s12890-017-0402-x

Cited by 13 publications

(11 citation statements)

References 27 publications

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“…These values are in line with what was assessed in other studies [3,15]. Moreover, previous studies suggested a relationship between the inhaled volume and body position, supposing hemidiaphragm movements being larger in supine than in both sitting and standing subjects [3,15].…”

Section: Discussionsupporting

confidence: 80%

“…This was particularly true during QB, indicating that, due to the wide variability of the breathing pattern at rest, a standardized breathing maneuver should be developed to minimize the risk of error. Normal limits were established from these measurements that were comparable with those reported in other studies using both ultrasonography [8,10] and alternative methods (such as fluoroscopy [3]), although those were obtained in standing or semirecumbent subjects. We analyzed a representative sample of the healthy population with a normal distribution of the main anthropometric parameters.…”

Section: Discussionsupporting

confidence: 58%

“…Several imaging methods were suggested to carry out diaphragm mobility assessment: fluoroscopy [3], computed tomography [4], magnetic resonance imaging [5], and chest radiography [6]. Each technique presents specific strengths and limitations, mainly relating to cost, radiation exposure, required expertise, and method availability [7].…”

Section: Introductionmentioning

confidence: 99%

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Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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Background: Assessing diaphragm mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics. Amongst several imaging methods, ultrasonography represents the only noninvasive, nonionizing imaging technique widely available for the direct assessment of diaphragm excursion. Objectives: the aim of this study is to prospectively assess the supine diaphragmatic motion amplitude, intra- and inter-observer agreement, and anthropometric correlates of diaphragm motion variability, measured through M-mode ultrasonography, in a sample of healthy volunteers. Methods: One-hundred healthy volunteers were considered eligible for the study. Instead of B-mode imaging, the M-mode technique was used to achieve a more accurate measurement of diaphragm motion. To assess intra-observer variability, 3 consecutive measurements (M-mode and B-mode) of the right dome motion were obtained at every session. To test for inter-rater reliability, the subjects were asked to provide 2 more diaphragm motion measurements every week, each performed by 2 experienced operators, and 42 subjects accepted. Results: Diaphragmatic motion was positively correlated with height and weight both at quiet (Spearman’s coefficient = 0.514, p < 0.001 and 0.314, p = 0.038) and deep breathing (Spearman’s coefficient = 0.342, p = 0.001 and 0.225, p = 0.024, respectively) and negatively correlated with age, but only during deep breathing (Spearman’s coefficient = –0.272, p = 0.006). Intra-observer agreement degree on all 3 measurements was excellent during both quiet and deep breathing, with a Cronbach’s alpha of 0.793 and 0.901, respectively, and an intra-class coefficient of 0.797 and 0.900, respectively. Similarly, the degree of inter-observer agreement achieved a Cronbach’s alpha of 0.638 and 0.776, and an inter-class coefficient of 0.632 and 0.778, respectively. Deep breathing was associated with sex only in linear multivariable models (B = –10.14; 95% confidence interval [CI] –17.86, –2.41; p = 0.011), while quiet breathing resulted to be affected by height only (B = 30.05; 95% CI 0.79–59.31; p = 0.044). Conclusions: Diaphragm excursion measurements using the M-mode technique were accurate and could be reproduced also when obtained in recumbent patients. After adjustments, the main predictors of diaphragmatic motion were sex and height, which should be considered to design a specifically tailored study and to develop normality reference equations.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 58%

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Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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“…In our sample as a whole, diaphragmatic mobility was found to be similar between males and females. Our results are consistent with those obtained by Saltiel et al, 15 Grams et al, 25 Pedrini, 26 and Leal et al, 27 who also found no difference in diaphragmatic mobility between males and females. However, Boussuges et al 28 and Kantarci et al 29 found differences in diaphragmatic mobility between males and females.…”

Section: Discussionsupporting

confidence: 94%

Comparison of diaphragmatic mobility between COPD patients with and without thoracic hyperkyphosis: a cross-sectional study

et al. 2018

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Objective:To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. Methods:Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. Results:A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = −0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). Conclusions:Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

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“…Dysfunction of the diaphragm is common and can be caused by trauma, surgery, cervical cord or phrenic nerve damage, inflammation and mediastinal mass, and various other reasons [1]. Functional analysis and quantification of motion for diaphragms have been performed using many imaging modalities, including conventional chest radiography [2][3][4], fluoroscopy [5][6][7], ultrasonography (US) [8][9][10][11][12], computed tomography (CT) [13], and magnetic resonance imaging (MRI) [14][15][16]. However, while understanding diaphragm kinetics is useful for monitoring, treatment, and management of respiratory diseases with diaphragm dysfunction the diaphragm's function and contribution to respiratory difficulties have not been fully investigated.…”

Section: Introductionmentioning

confidence: 99%

Time-resolved quantitative evaluation of diaphragmatic motion during forced breathing in a health screening cohort in a standing position: Dynamic chest phrenicography

Hida

Yamada

Ueyama

et al. 2019

European Journal of Radiology

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To assess diaphragmatic motion during forced breathing in a health screening center cohort by timeresolved quantitative analysis using dynamic chest radiography and demonstrate the characteristics and associations with demographics and pulmonary function of participants. Materials and methods: This prospective study includes 174 volunteers (99 males; median 57, range 36-93 years old) that underwent dynamic chest radiography with a flat panel detector system during forced breathing in a standing position. We automatically tracked and recorded the positions of the top of the diaphragms and the excursions on images of each participant and calculated peak motion speeds based on the data. We investigated the associations with demographics and pulmonary function statistically. Results: The average excursions of the diaphragms during forced breathing were 49.1 ± 17.0 mm (right; mean ± standard deviation) and 52.1 ± 15.9 mm (left). The peak motion speeds were 26.7 ± 10.0 mm/s (right) and 32.2 ± 12.4 mm/s (left) in the inspiratory phase and 22.1 ± 12.7 mm/s (right) and 24.3 ± 10.3 mm/s (left) in the expiratory phase. Excursions and peak motion speeds of the left diaphragm were significantly greater than the right. Higher body mass index (BMI) and vital capacity (VC) were associated with greater excursions and faster peak motion speeds of the diaphragms. Conclusions: Time-resolved quantitative analysis of the diaphragms with dynamic chest radiography demonstrated the characteristics of diaphragmatic motion during forced breathing in a health screening cohort. Higher BMI and VC were associated with excursions and peak motion speeds of the diaphragms.

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Validity and reliability of fluoroscopy for digital radiography: a new way to evaluate diaphragmatic mobility

Cited by 13 publications

References 27 publications

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Comparison of diaphragmatic mobility between COPD patients with and without thoracic hyperkyphosis: a cross-sectional study

Time-resolved quantitative evaluation of diaphragmatic motion during forced breathing in a health screening cohort in a standing position: Dynamic chest phrenicography

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