Future expectations for respiratory disease assessment in dynamic chest radiography.
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ABSTRACT:
SUBMITTER: Hanaoka J
PROVIDER: S-EPMC10797365 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
Publications
Future expectations for respiratory disease assessment in dynamic chest radiography.
Journal of thoracic disease 20231206 12
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Project description:Dynamic chest radiography (DCR) is a real-time sequential high-resolution digital X-ray imaging system of the thorax in motion over the respiratory cycle, utilising pulsed image exposure and a larger field of view than fluoroscopy coupled with a low radiation dose, where post-acquisition image processing by computer algorithm automatically characterises the motion of thoracic structures. We conducted a systematic review of the literature and found 29 relevant publications describing its use in humans including the assessment of diaphragm and chest wall motion, measurement of pulmonary ventilation and perfusion, and the assessment of airway narrowing. Work is ongoing in several other areas including assessment of diaphragmatic paralysis. We assess the findings, methodology and limitations of DCR, and we discuss the current and future roles of this promising medical imaging technology.Critical relevance statement Dynamic chest radiography provides a wealth of clinical information, but further research is required to identify its clinical niche.
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Project description:Dynamic digital radiography (DDR) is a high-resolution radiographic imaging technique using pulsed X-ray emission to acquire a multiframe cine-loop of the target anatomical area. The first DDR technology was orthostatic chest acquisitions, but new portable equipment that can be positioned at the patient's bedside was recently released, significantly expanding its potential applications, particularly in chest examination. It provides anatomical and functional information on the motion of different anatomical structures, such as the lungs, pleura, rib cage, and trachea. Native images can be further analyzed with dedicated post-processing software to extract quantitative parameters, including diaphragm motility, automatically projected lung area and area changing rate, a colorimetric map of the signal value change related to respiration and motility, and lung perfusion. The dynamic diagnostic information along with the significant advantages of this technique in terms of portability, versatility, and cost-effectiveness represents a potential game changer for radiological diagnosis and monitoring at the patient's bedside. DDR has several applications in daily clinical practice, and in this narrative review, we will focus on chest imaging, which is the main application explored to date in the literature. However, studies are still needed to understand deeply the clinical impact of this method.
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| S-EPMC10797375 | biostudies-literature
Project description:PurposeAccurate preoperative assessment of tumor invasion/adhesion is crucial for planning appropriate operative procedures. Recent advances in digital radiography allow a motion analysis of lung tumors with dynamic chest radiography (DCR) with total exposure dose comparable to that of conventional chest radiography. The aim of this study was to investigate the feasibility of preoperative evaluation of pleural invasion/adhesion of lung tumors with DCR through a virtual clinical imaging study, using a four-dimensional (4D) extended cardiac-torso (XCAT) computational phantom.MethodsAn XCAT phantom of an adult man (50th percentile in height and weight) with simulated respiratory and cardiac motions was generated to use as a virtual patient. To simulate lung tumors with and without pleural invasion, a 30-mm diameter tumor sphere was inserted into each lobe of the phantom. The virtual patient during respiration was virtually projected using an x-ray simulator in posteroanterior (PA) and oblique directions, and sequential bone suppression (BS) images were created. The measurement points (tumor, rib, and diaphragm) were automatically tracked on simulated images by a template matching technique. We calculated five quantitative metrics related to the movement distance and directions of the targeted tumor and evaluated whether DCR could distinguish between tumors with and without pleural invasion/adhesion.ResultsPrecise tracking of the targeted tumor was achieved on the simulated BS images without undue influence of rib shadows. There was a significant difference in all five quantitative metrics between the lung tumors with and without pleural invasion both on the oblique and PA projection views (P < 0.05). Quantitative metrics related to the movement distance were effective for tumors in the middle and lower lobes, while, those related to the movement directions were effective for tumors close to the frontal chest wall on the oblique projection view. The oblique views were useful for the evaluation of the space between the chest wall and a moving tumor.ConclusionDCR could help distinguish between tumors with and without pleural invasion/adhesion based on the two-dimensional movement distance and direction using oblique and PA projection views. With anticipated improved image: processing to evaluate the respiratory displacement of lung tumors in the upper lobe or behind the heart, DCR holds promise for clinical assessment of tumor invasion/adhesion in the parietal pleura.
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Project description:BackgroundTo plan a surgical approach and predict the operative time or bleeding volume, it is important to determine the presence of pleural adhesions before surgery. Dynamic chest radiography (DCR) is a new modality that can dynamically capture X-rays, and we assessed the utility of DCR for detecting pleural adhesions preoperatively.MethodsThe subjects of this study were those who underwent DCR before surgery from January 2020 to May 2022. The preoperative evaluation was performed by three imaging analysis modes, and pleural adhesion was defined as the that spreading to more than 20% of the thoracic cavity and/or taking more than 5 minutes to dissect.ResultsOf the 120 total patients, DCR was performed properly for 119 (99.2%). Accurate preoperative evaluations of pleural adhesions were confirmed in 101 patients (84.9%), with a sensitivity of 64.5%, specificity of 91.0%, positive predictive value of 74.1%, and negative predictive value of 88.0%.ConclusionsDCR was very easy to perform in all preoperative patients with all manner of thoracic disease. We demonstrated the utility of DCR, showing its high specificity and negative predictive value. DCR has the potential to become a common preoperative examination for detecting pleural adhesions with further improvements in software programs.
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Project description:Chest digital dynamic radiography (DDR) is a novel method for evaluating pulmonary perfusion and ventilation. It could depict ventilation-perfusion mismatch in a pulmonary artery sarcoma with severe stenosis in the right pulmonary artery. This report is the first demonstration of ventilation-perfusion mismatch in a malignant neoplasm using DDR.
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Project description:Respiratory X-ray imaging enhanced by phase contrast has shown improved airway visualization in animal models. Limitations in current X-ray technology have nevertheless hindered clinical translation, leaving the potential clinical impact an open question. Here, we explore phase-contrast chest radiography in a realistic in silico framework. Specifically, we use preprocessed virtual patients to generate in silico chest radiographs by Fresnel-diffraction simulations of X-ray wave propagation. Following a reader study conducted with clinical radiologists, we predict that phase-contrast edge enhancement will have a negligible impact on improving solitary pulmonary nodule detection (6 to 20 mm). However, edge enhancement of bronchial walls visualizes small airways (< 2 mm), which are invisible in conventional radiography. Our results show that phase-contrast chest radiography could play a future role in observing small-airway obstruction (e.g., relevant for asthma or early-stage chronic obstructive pulmonary disease), which cannot be directly visualized using current clinical methods, thereby motivating the experimental development needed for clinical translation. Finally, we discuss quantitative requirements on distances and X-ray source/detector specifications for clinical implementation of phase-contrast chest radiography.
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