18F-FDG PET/CT and 68Ga-DOTA-FAPI-04 PET/CT Findings of Myeloid Sarcoma

ABSTRACT

A 28-year-old woman presented with a 2-month history of swelling and pain in the chest wall. An irregular soft tissue mass in the chest wall and mediastinum was showed on chest CT. 18F-FDG PET/CT revealed obvious FDG uptake in the mass. Subsequently, the patient was participated in a 68Ga-DOTA-FAPI-04 PET/CT tumor clinical trial. 68Ga-DOTA-FAPI-04 PET/CT also showed elevated tracer uptake in the mass. Biopsy of the mass confirmed a diagnosis of myeloid sarcoma.

Comparative Morphological Evaluation of Young Women's Breast-Bra Reshaping by Different Bra Cups

Female breasts are regarded as a factor reflecting women's morphological beauty. An appropriate bra can fulfill aesthetic needs, thus boosting self-esteem. This study proposed a method to analyze young women's breast-bra morphological variations between two identical bras with different bra cup thicknesses. The 3D surface scan data of 129 female students who were braless and wore a thin bra (13 mm) and a thick bra (23 mm) were analyzed. Integral sections of the breasts and bra were cut at a fixed thickness of 10 mm, and slice maps were derived. Morphological parameters were extracted in braless and the two bra conditions. The variations in breast-bra shape caused by different thicknesses of bra cups were evaluated by quantifying breast ptosis, gathering, and breast slice area. The results showed that the thin bra lifted the breasts by 2.16 cm, whereas the thick bra decreased breast separation, gathering the breasts and moving them 2.15 cm laterally towards the center of the chest wall. Moreover, prediction models constructed using the critical morphological parameters were used to characterize breast-bra shape after wearing the provided bras. The findings lay the groundwork for quantifying the breast-bra shape variation caused by different bra cup thicknesses, allowing young females to choose optimally fitting bras to achieve their desired breast aesthetics.

Evaluation of congenital rib anomalies with multi-detector computed tomography in the Turkish population

BACKGROUND

This study aimed to evaluate the congenital anomalies of ribs in the Turkish population using multi-detector computed tomography (CT) and to reveal the prevalence and distribution of these anomalies according to sexes and body sides.

MATERIALS AND METHODS

This study included 1120 individuals (592 male, 528 female) over 18 who presented to our hospital with a suspicion of COVID-19 and who had thoracic CT. Anomalies such as a bifid rib, cervical rib, fused rib, Srb anomaly, foramen rib, hypoplastic rib, absent rib, supernumerary rib, pectus carinatum, and pectus excavatum, which were previously defined in the literature, were examined. Descriptive statistics were performed with the distribution of anomalies. Comparisons were made between the sexes and body sides.

RESULTS

A prevalence of 18.57% rib variation was observed. Females had 1.3 times more variation than males. Although there was a significant difference in the distribution of anomalies by sex (p = 0.000), there was no difference in terms of body side of anomaly (p > 0.05). The most common anomaly was the hypoplastic rib, followed by the absence of a rib. While the incidence of the hypoplastic rib was similar in females and males, 79.07% of the absent ribs was seen in females (p < 0.05). The study also includes a rare case of bilateral first rib foramen. At the same time, this study includes a rare case of rib spurs extending from the left 11th rib to the 11th intercostal space.

CONCLUSIONS

This study demonstrates detailed information about congenital rib anomalies in the Turkish population, which may vary between people. Knowing these anomalies is essential for anatomy, radiology, anthropology, and forensic sciences.

Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study

Following mastectomy for breast cancer, women may choose implant-based reconstruction for many reasons, such as cosmesis, self-identity, and the ability to wear particular items of clothing. However, postmastectomy radiation therapy (PMRT) can compromise these cosmetic goals, including as much as a 40% loss of implant rate. To minimize the risk of radiation toxicity, it is important to consider how clinical target volumes (CTVs) can be optimized in PMRT to preserve the implant and reduce complications. Typically, guidelines from organizations such as the Radiation Oncology Group are used, which include regions previously encompassed by tangential fields. This includes all structures below the pectoralis muscle, such as the chest wall, where the risk of recurrence is negligible; this technique often requires incidental inclusion of portions of the lung and heart plus circumferential radiation of the implant. We present the preliminary single institution case series of a technique of complication avoidance of reconstruction implant radiation therapy, called CARIT, where the chest wall, and a large proportion of the implant, is not irradiated. In a retrospective review of 30 cases in which CARIT has been attempted, it was found that 24% of patients treated required a second surgery due to Baker grade III/IV capsular contracture. Using the Modified Harvard Harris Cosmetic Scale, 66.5% of patients had cosmetic outcomes rated as "good" or "excellent". CARIT could offer a technique to reduce complications in postmastectomy implant-based reconstruction patients, with our next steps focusing on improving dosimetry, and formally comparing the cosmesis and tumor control aspects with commonly used techniques.

Linear and Non-Linear Heart Rate Variability Indexes from Heart-Induced Mechanical Signals Recorded with a Skin-Interfaced IMU

Heart rate variability (HRV) indexes are becoming useful in various applications, from better diagnosis and prevention of diseases to predicting stress levels. Typically, HRV indexes are retrieved from the heart's electrical activity collected with an electrocardiographic signal (ECG). Heart-induced mechanical signals recorded from the body's surface can be utilized to record the mechanical activity of the heart and, in turn, extract HRV indexes from interbeat intervals (IBIs). Among others, accelerometers and gyroscopes can be used to register IBIs from precordial accelerations and chest wall angular velocities. However, unlike electrical signals, the morphology of mechanical ones is strongly affected by body posture. In this paper, we investigated the feasibility of estimating the most common linear and non-linear HRV indexes from accelerometer and gyroscope data collected with a wearable skin-interfaced Inertial Measurement Unit (IMU) positioned at the xiphoid level. Data were collected from 21 healthy volunteers assuming two common postures (i.e., seated and lying). Results show that using the gyroscope signal in the lying posture allows accurate results in estimating IBIs, thus allowing extracting of linear and non-linear HRV parameters that are not statistically significantly different from those extracted from reference ECG.

Effects of different virtual monoenergetic CT image data on chest wall post-processing "unfolded ribs" and proposal of an algorithm improvement

PURPOSE

To find out if the use of different virtual monoenergetic data sets enabled by DECT technology might have a negative impact on post-processing applications, specifically in case of the "unfolded ribs" algorithm. Metal or beam hardening artifacts are suspected to generate image artifacts and thus reduce diagnostic accuracy. This paper tries to find out how the generation of "unfolded rib" CT image reformates is influenced by different virtual monoenergetic CT images and looks for possible improvement of the post-processing tool.

MATERIAL AND METHODS

Between March 2021 and April 2021, thin-slice dual-energy CT image data of the chest were used creating "unfolded rib" reformates. The same data sets were analyzed in three steps: first the gold standard with the original algorithm on mixed image data sets followed by the original algorithm on different keV levels (40-120 keV) and finally using a modified algorithm which in the first step used segmentation based on mixed image data sets, followed by segmentation based on different keV levels. Image quality (presence of artifacts), lesion and fracture detectability were assessed for all series.

RESULTS

Both, the original and the modified algorithm resulted in more artifact-free image data sets compared to the gold standard. The modified algorithm resulted in significantly more artifact-free image data sets at the keV-edges (40-120 keV) compared the original algorithm. Especially "black artifacts" and pseudo-lesions, potentially inducing false positive findings, could be reduced in all keV level with the modified algorithm. Detection of focal sclerotic, lytic or mixed (k = 0.990-1.000) lesions was very good for all keV levels. The Fleiss-kappa test for detection of fresh and old rib fractures was ≥ 0.997.

CONCLUSION

The use of different virtual monoenergetic keVs for the "unfolded rib" algorithm is generating different artifacts. Segmentation-based artifacts could be eliminated by the proposed new algorithm, showing the best results at 70-80 keV.

Incidentalomas in chest CT

Advances in imaging technology have dramatically increased the resolution of CT and improved detection of disease; these advances also have led to an increase in incidentalomas or incidental findings that often do not represent significant disease. Incidental findings on thoracic CT are common and can be problematic and expensive to evaluate. Thoracic imagers often are having to make recommendations for appropriate management which adds to the burden. Thoracic CT incidental findings are broad and include those of the lungs, heart, mediastinum, pleura, chest wall, thoracic soft tissues as well as the lower neck and upper abdomen. Of these, incidental pulmonary nodules have garnered the most interest over the years, but all incidentals may be proven to represent significant disease. In the USA, the American College of Radiology has generated white papers on incidentals that have proven useful. Currently, a number of investigations to utilize artificial intelligence for qualification and management of incidentals are ongoing. Likewise, the radiology/imaging community must support efforts to collaboratively address incidental findings and management concerns. As such, continued efforts to establish guidelines for appropriate identification, classification and management of incidentals is important to improve patient care and assure fiscally responsible assessment.

Development of deep-inspiration breath-hold system that monitors the position of the chest wall using infrared rangefinder

We conducted a prospective study to quantitatively evaluate the movement of the chest wall to establish the simple and reproducible deep-inspiration breath-hold (DIBH) method. The left nipple position was monitored to confirm the inspiratory state. Planning computed tomography (CT) was performed under DIBH and free-breath. We conducted radiation plans with DIBH and free-breath CT and evaluated organ at risk (OAR) and target doses according to two different plans. The relationship between positioning errors of the chest wall and patient factors was evaluated using univariate analysis and fixed-effects models. Twenty-three patients aged ≤ 60 years were enrolled during January-August 2021; 358 daily radiation treatments were evaluated. The median time of treatment room occupancy was 16 minutes (interquartile range, 14-20). The area of the planning target volume (PTV) surrounded by the 95% isodose line was more extensive in DIBH than in free breathing (71.6% vs 69.5%, P < 0.01), whereas the cardiac and left anterior descending (LAD) artery doses were lower (both P < 0.01). In the fixed-effects model analysis, the occupation time of the treatment room was correlated with positioning error. The difference between the planned and irradiated dose was the largest in the LAD branch of the coronary artery (-2.5 Gy), although the OAR dose decreased owing to positional error. The current DIBH method, wherein a single point on the chest wall is monitored to confirm that the patient is in an inspiratory state, allows radiation to be performed in a short time with a small dose error.

Desmoid fibroma simulating malignant breast neoplasm: A case report and literature review

INTRODUCTION

Desmoid fibroma (DF) is a disorder characterized by strong clonal proliferation of myofibroblasts and fibroblasts. We describe a case of DF that mimicked a breast tumor, along with a review of the literature on the clinical manifestation, diagnostic process, and course of therapy for this combative disease.

CASE REPORT

A 34-year-old female patient with breast lump at the junction of the upper quadrants of the left breast. After the diagnosis of DF, it was decided to perform a sectorectomy of the left breast associated with post-quadrant reconstruction, with immunohistochemistry and findings compatible with DF.

DISCUSSION

Clinically manifests as a solid mass that is often painless and occasionally adherent to the chest wall. A treatment strategy should be idealized for each patient. Thus, there is the possibility of performing radical surgery for resection and/or radiotherapy, and surgery may be followed by radiotherapy.

Variations of accessory thoracic muscles identified in the ethnically diverse whole-body donation population in Northern California

Accessory thoracic muscles in humans are relatively common and it is important to draw awareness to their variable presentations and potential clinical implications owing to their close association with the axilla. Here we report four cases of accessory thoracic muscle variations identified in the ethnically diverse whole- -body donation population in Northern California (4 out of 48 donors, 8.3%). Of these, combined presentations of thoracic accessory muscles were observed in two of the donors, one involving bilateral axillary arches and a pectoralis quartus on the left and the other a unilateral axillary arch on the left and bilateral pairs of pectoral fascicles. In the former, the proximal ends of the left axillary arch and pectoralis quartus joined to form a common aponeurosis which inserted onto the deep tendon of the pectoralis major; in the latter, the pectoral fascicles originated from the surface of the ribs and inserted into the deep surface of the pectoralis major muscle. In the other two donors, unilateral axillary arches were observed. Our observations illustrate that accessory thoracic muscles, in isolated as well as combined forms, are commonplace in the general population. We also describe the proposed embryonic origins of these accessory muscles, which may reflect their frequent occurrence, and potential clinical implications of these muscles, as discussed in literature.

Reviving a successful blunt chest wall injury protocol

This article describes a quality improvement project that assessed nurses' knowledge and practices for patients admitted with a blunt chest wall injury and utilized interactive learning to revive the use of the protocol.

The diagnostic value of magnetic resonance imaging compared to computed tomography in the evaluation of fat-containing thoracic lesions

Intrathoracic fat-containing lesions may arise in the mediastinum, lungs, pleura, or chest wall. While CT can be helpful in the detection and diagnosis of these lesions, it can only do so if the lesions contain macroscopic fat. Furthermore, because CT cannot demonstrate microscopic or intravoxel fat, it can fail to identify and diagnose microscopic fat-containing lesions. MRI, employing spectral and chemical shift fat suppression techniques, can identify both macroscopic and microscopic fat, with resultant enhanced capability to diagnose these intrathoracic lesions non-invasively and without ionizing radiation. This paper aims to review the CT and MRI findings of fat-containing lesions of the chest and describes the fat-suppression techniques utilized in their assessment.

After-effects of thixotropic conditionings on operational chest wall and compartmental volumes of patients with Parkinson's disease

Individuals with Parkinson's disease (PD) present respiratory dysfunctions, mainly due to decreased chest wall expansion, which worsens with the course of the disease. These findings contribute to the restrictive respiratory pattern and the reduction in chest wall volume. According to literature, inspiratory muscle thixotropic conditioning maneuvers may improve lung volumes in these patients. The study aimed to determine the after-effects of respiratory muscle thixotropic maneuvers on breathing patterns and chest wall volumes of PD. A crossover study was performed with twelve patients with PD (8 males; mean age 63.9±8.8 years, FVC%pred 89.7±13.9, FEV1%pred 91.2±15, FEV1/FVC%pred 83.7±5.7). Chest wall volumes were assessed using OEP during thixotropic maneuvers. Increases in EIVCW (mean of 126mL, p = 0.01) and EEVCW (mean of 150mL, p = 0.005) were observed after DITLC (deep inspiration from total lung capacity) due to increases in pulmonary (RCp) and abdominal (RCa) ribcage compartments. Changes in ICoTLC (inspiratory contraction from TLC) led to significant EIVCW (mean of 224mL, p = 0.001) and EEVCW (mean of 229mL, p = 0.02) increases that were mainly observed in the RCp. No significant changes were found when performing DERV (deep expiration from residual volume) and ICoRV (Inspiratory contraction from RV). Positive correlations were also observed between the degree of inspiratory contraction during ICoTLC and EEVRCp (rho = 0.613, p = 0.03) and EIVRCp (rho = 0.697, p = 0.01) changes. Thixotropy conditioning of inspiratory muscles at an inflated chest wall volume increases EIVCW and EEVCW in the ten subsequent breaths in PD patients. These maneuvers are easy to perform, free of equipment, low-cost, and may help patients improve chest wall volumes during rehabilitation.

Measurement and Analysis of Lobar Lung Deformation After a Change of Patient Position During Video-Assisted Thoracoscopic Surgery

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical technique for the diagnosis and treatment of early-stage lung cancer. During VATS, large lung deformation occurs as a result of a change of patient position and a pneumothorax (lung deflation), which hinders the intraoperative localization of pulmonary nodules. Modeling lung deformation during VATS for surgical navigation is desirable, but the mechanisms causing such deformation are yet not well-understood. In this study, we estimate, quantify and analyze the lung deformation occurring after a change of patient position during VATS. We used deformable image registration to estimate the lung deformation between a preoperative CT (in supine position) and an intraoperative CBCT (in lateral decubitus position) of six VATS clinical cases. We accounted for sliding motion between lobes and against the thoracic wall and obtained consistently low average target registration errors (under 1 mm). We observed large lung displacement (up to 40 mm); considerable sliding motion between lobes and against the thoracic wall (up to 30 mm); and localized volume changes indicating deformation. These findings demonstrate the complexity of the change of patient position phenomenon, which should necessarily be taken into account to model lung deformation for intraoperative guidance during VATS.

Paradoxical response to chest wall loading predicts a favorable mechanical response to reduction in tidal volume or PEEP

BACKGROUND

Chest wall loading has been shown to paradoxically improve respiratory system compliance (C_RS) in patients with moderate to severe acute respiratory distress syndrome (ARDS). The most likely, albeit unconfirmed, mechanism is relief of end-tidal overdistension in 'baby lungs' of low-capacity. The purpose of this study was to define how small changes of tidal volume (V_T) and positive end-expiratory pressure (PEEP) affect C_RS (and its associated airway pressures) in patients with ARDS who demonstrate a paradoxical response to chest wall loading. We hypothesized that small reductions of V_T or PEEP would alleviate overdistension and favorably affect C_RS and conversely, that small increases of V_T or PEEP would worsen C_RS.

METHODS

Prospective, multi-center physiologic study of seventeen patients with moderate to severe ARDS who demonstrated paradoxical responses to chest wall loading. All patients received mechanical ventilation in volume control mode and were passively ventilated. Airway pressures were measured before and after decreasing/increasing V_T by 1 ml/kg predicted body weight and decreasing/increasing PEEP by 2.5 cmH₂O.

RESULTS

Decreasing either V_T or PEEP improved C_RS in all patients. Driving pressure (DP) decreased by a mean of 4.9 cmH₂O (supine) and by 4.3 cmH₂O (prone) after decreasing V_T, and by a mean of 2.9 cmH₂O (supine) and 2.2 cmH₂O (prone) after decreasing PEEP. C_RS increased by a mean of 3.1 ml/cmH₂O (supine) and by 2.5 ml/cmH₂O (prone) after decreasing V_T. C_RS increased by a mean of 5.2 ml/cmH₂O (supine) and 3.6 ml/cmH₂O (prone) after decreasing PEEP (P < 0.01 for all). Small increments of either V_T or PEEP worsened C_RS in the majority of patients.

CONCLUSION

Patients with a paradoxical response to chest wall loading demonstrate uniform improvement in both DP and C_RS following a reduction in either V_T or PEEP, findings in keeping with prior evidence suggesting its presence is a sign of end-tidal overdistension. The presence of 'paradox' should prompt re-evaluation of modifiable determinants of end-tidal overdistension, including V_T, PEEP, and body position.

Radar Evaluation Setup for the Replication of Chest Wall Movement from Vital Signs

In this paper we present a setup to generate micro movement which is analog to the chest wall micro movement from vital signs. The movement is produced by a loudspeaker powered by a function generator. Since it is difficult to isolate and reproduce effects in the context of vital signs measurements with the human body, this setup allows an easier development of radar post processing algorithms. In addition, some effects are difficult to measure with a human, for example heart diseases like cardiac arrhythmia. To evaluate the setup, we present reference measurements with a human. Also, we show the results of measurements with the setup made with three different radar systems, which use different center frequencies: 24 GHz, 60 GHz and 77 GHz. The setup is able to create absolutely smooth and exact movement which is linear to the applied voltage. This is important in order to simulate several effects in the heart and breathing movement.

The association of internal mammary and medial supraclavicular lymph node radiation technique with clinical outcomes: Results from the EORTC 22922/10925 randomised trial

BACKGROUND AND PURPOSE

The multicentre EORTC 22922/10925 trial (ClinicalTrials.gov, NCT00002851) was conducted between 1996 and 2004. The trial evaluated the effect of irradiation of the internal mammary and medial supraclavicular lymph node chains (IM-MS) vs no further radiation therapy (RT) on survival and cause of death in breast cancer stage I-III patients. At 15.7 years of median follow-up, a significant reduction of breast cancer specific mortality (BCSM) and any recurrence, not translating in improved overall survival (OS), and low absolute rates of side effects were found. The aim of the current analysis was to evaluate the association of RT techniques of IM-MS lymph node irradiation with long-term outcomes.

PATIENTS AND METHODS

Three RT techniques were used for IM-MS: a standard technique using a fixed set-up combining photon/electron beams to the IM and tangential fields to the breast or chest wall vs a standard-modified technique with minor adaptation for beam settings vs a more individualised technique based on individual localisation of the IM. Techniques used were fixed per institution over the duration of the trial. We performed an exploratory and descriptive analysis of the outcomes after 15 years follow-up for the three RT techniques.

RESULTS

Between July 1996 and January 2004, 46 radiation oncology departments from 13 countries accrued 4004 patients. Median follow-up was 15.7 years. The number of patients treated by each technique was 2440 (61%) by standard vs 635 (16%) by standard-modified vs 929 (23%) patients by individualised technique. The absolute improvements of oncological outcomes in terms of disease-free survival (DFS), OS and BCSM with IM-MS RT compared to no IM-MS RT were 6.8%, 4.9% and -5.8% for the individualised technique, vs 1.6%, 2.9% and -4.3% for modified standard and -1.4%, 1.1% and -3% for standard technique, respectively. The increase in 15-year rates of side effects due to IM-MS RT, both scored longitudinally and cross-sectionally, were similar among the techniques.

CONCLUSION

Even though a straightforward comparison by technique is not possible because of variations in baseline characteristics between institutions, our findings suggest that the use of more individualised RT techniques is associated with higher rates of oncological improvements without increased risks for late side effects.

Non-contact Blood Pressure Estimation Method Based on Blood Pressure Category Classification

In recent years, non-contact Blood Pressure (BP) measurement has been attracting attention for measuring our health status in daily life. A Doppler radar can observe pulse waves caused by chest wall displacement due to heartbeat. BP can be estimated by constructing a BP estimation model using BP-related features obtained from the pulse wave. However, compared to when modeling for each subject, the BP esti-mation accuracy deteriorates significantly when modeling with multiple subjects including the testing subject. To deal with this limitation, BP category classification has been introduced into PhotoPlethysmoGraphy (PPG)-based BP estimation. In this paper, we develop a Doppler radar-based BP estimation method based on BP category classification. In the proposed method, the pulse waves extracted from a Doppler radar are classified into three categories, "Low BP", "Normal BP", and "High BP" by k-Nearest Neighbor (kNN) based on the features that correlate with BP. The SBP estimation model is trained for each BP category. After the BP category classification, SBP is then estimated by using the model corresponding to the classified BP category. The experimental results showed that the proposed method with BP category classification estimated SBP accurately, compared to without BP category classification.

Outcomes and toxicity following post-operative hypofractionated radiotherapy to the regional nodes and the breast or the chest wall in locally advanced breast cancer

OBJECTIVES

We aimed to analyze the impact of a 3-week schedule of HypoFractionated (HF) radiotherapy (RT) after axillary dissection and breast surgery, in terms of safety and efficacy in patients with locally advanced breast cancer (BC).

METHODS

Eligible patients were females with Stage IIA - IIIC BC who underwent axillary dissection and breast surgery, either quadrantectomy or mastectomy. HF RT was delivered in 15 or 16 fractions for a total dose of 40.05 Gy or 42.56 Gy, respectively, to the clavicular nodal region along with the whole breast (HF WBRT) or the chest wall (HF PMRT), according to the type of surgery. Locoregional recurrence (LRR), distant metastases-free survival (DMFS), overall survival (OS) and acute and late treatment-related toxicities were estimated.

RESULTS

57 patients with a median age of 60 years (32-85) were retrospectively analyzed. 34 (60%) of patients underwent breast conservative surgery in the form of quadrantectomy and 23 (40%) were offered radical mastectomy. All patients underwent hypofractionated regional nodal irradiation (HF RNI). 34 (60%) of them underwent HF WBRT, while 23 (40%) received HF PMRT.At a median follow-up of 80 months (30-113), the 7-year LRR-free survival was 93% (95% CI, 74%-95%). The same features for DMFS and OS were 76% (95% CI, 52%-78%) and 67% (95% CI, 50%-80%), respectively. Only one (2%) patient experienced G3 acute skin toxicity. No grade ≥2 late toxicity was observed.

CONCLUSION

Our study shows that HF RNI with HF RT to the whole breast or the chest wall after breast surgery is safe and effective in patients with locally advanced BC. Longer follow-up is needed to strengthen further analyses on late toxicity and clinical outcomes.

ADVANCES IN KNOWLEDGE

This paper adds to the evidence that post-operative RNI with WBRT or PMRT can be safely and effectively delivered with 3-week HF regimen. Locally advanced BC patients can be offered HF RT to the regional nodes and the breast or the chest wall regardless the type of surgery.

Influence of chest wall conformation on spirometry parameters and outcome in mild-to-moderate idiopathic pulmonary fibrosis

Extrinsic causes of restrictive lung syndrome in idiopathic pulmonary fibrosis (IPF) patients have been poorly investigated. We aimed to investigate the influence of the anterior chest wall deformity, noninvasively assessed by modified Haller index (MHI), on spirometry parameters and outcome in a consecutive population of patients with mild-to-moderate IPF. Sixty consecutive IPF patients (73.8 ± 6.6 years, 45 males) were included in this retrospective study. All patients underwent physical examination, spirometry, blood tests, conventional transthoracic echocardiography and MHI assessment (chest transverse diameter over the distance between sternum and spine) at basal evaluation. During follow-up, we evaluated the composite endpoint of (1) pulmonary or cardiovascular hospitalizations and (2) all-cause mortality. IPF patients with concave-shaped chest wall (MHI > 2.5) (36.7% of total) and those with normal chest shape (MHI ≤ 2.5) (63.3%) were separately analyzed. In comparison to IPF patients with MHI ≤ 2.5, those with MHI > 2.5: were less likely to be men and smokers; had a more severe restrictive pattern; had significantly smaller cardiac chamber dimensions and significantly higher systolic pulmonary artery pressure (51.9 ± 15.1 vs 42.4 ± 14.3 mmHg, p = 0.02). Mean follow-up time was 2.5 ± 1.4 years. During follow-up, 13 deaths and 16 pulmonary or cardiovascular hospitalizations were detected. At multivariate Cox regression analysis, concave-shaped chest wall (MHI > 2.5) (HR 4.55, 95% CI 1.02-20.4), increased C-reactive protein (HR 1.68, 95% CI 1.08-2.61) and absence of beta-blocker therapy (HR 0.13, 95% CI 0.01-0.26) were independently associated to the investigated outcome. MHI assessment and implementation may help the clinician to identify, among IPF patients, those with poorer prognosis over a medium-term follow-up.