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Yoshida A, Kai C, Futamura H, Oochi K, Kondo S, Sato I, Kasai S. Spirometry test values can be estimated from a single chest radiograph. Front Med (Lausanne) 2024; 11:1335958. [PMID: 38510449 PMCID: PMC10953498 DOI: 10.3389/fmed.2024.1335958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Physical measurements of expiratory flow volume and speed can be obtained using spirometry. These measurements have been used for the diagnosis and risk assessment of chronic obstructive pulmonary disease and play a crucial role in delivering early care. However, spirometry is not performed frequently in routine clinical practice, thereby hindering the early detection of pulmonary function impairment. Chest radiographs (CXRs), though acquired frequently, are not used to measure pulmonary functional information. This study aimed to evaluate whether spirometry parameters can be estimated accurately from single frontal CXR without image findings using deep learning. Methods Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC as spirometry measurements as well as the corresponding chest radiographs of 11,837 participants were used in this study. The data were randomly allocated to the training, validation, and evaluation datasets at an 8:1:1 ratio. A deep learning network was pretrained using ImageNet. The input and output information were CXRs and spirometry test values, respectively. The training and evaluation of the deep learning network were performed separately for each parameter. The mean absolute error rate (MAPE) and Pearson's correlation coefficient (r) were used as the evaluation indices. Results The MAPEs between the spirometry measurements and AI estimates for FVC, FEV1 and FEV1/FVC were 7.59% (r = 0.910), 9.06% (r = 0.879) and 5.21% (r = 0.522), respectively. A strong positive correlation was observed between the measured and predicted indices of FVC and FEV1. The average accuracy of >90% was obtained in each estimation of spirometry indices. Bland-Altman analysis revealed good agreement between the estimated and measured values for FVC and FEV1. Discussion Frontal CXRs contain information related to pulmonary function, and AI estimation performed using frontal CXRs without image findings could accurately estimate spirometry values. The network proposed for estimating pulmonary function in this study could serve as a recommendation for performing spirometry or as an alternative method, suggesting its utility.
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Affiliation(s)
- Akifumi Yoshida
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
| | - Chiharu Kai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Japan
| | | | | | - Satoshi Kondo
- Graduate School of Engineering, Muroran Institute of Technology, Muroran, Japan
| | - Ikumi Sato
- Major in Health and Welfare, Graduate School of Niigata University of Health and Welfare, Niigata, Japan
- Department of Nursing, Faculty of Nursing, Niigata University of Health and Welfare, Niigata, Japan
| | - Satoshi Kasai
- Department of Radiological Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
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O’Regan PW, Stevens NE, Logan N, Ryan DJ, Maher MM. Paediatric Thoracic Imaging in Cystic Fibrosis in the Era of Cystic Fibrosis Transmembrane Conductance Regulator Modulation. CHILDREN (BASEL, SWITZERLAND) 2024; 11:256. [PMID: 38397368 PMCID: PMC10888261 DOI: 10.3390/children11020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Cystic fibrosis (CF) is one of the most common progressive life-shortening genetic conditions worldwide. Ground-breaking translational research has generated therapies that target the primary cystic fibrosis transmembrane conductance regulator (CFTR) defect, known as CFTR modulators. A crucial aspect of paediatric CF disease is the development and progression of irreversible respiratory disease in the absence of clinical symptoms. Accurate thoracic diagnostics have an important role to play in this regard. Chest radiographs are non-specific and insensitive in the context of subtle changes in early CF disease, with computed tomography (CT) providing increased sensitivity. Recent advancements in imaging hardware and software have allowed thoracic CTs to be acquired in paediatric patients at radiation doses approaching that of a chest radiograph. CFTR modulators slow the progression of CF, reduce the frequency of exacerbations and extend life expectancy. In conjunction with advances in CT imaging techniques, low-dose thorax CT will establish a central position in the routine care of children with CF. International guidelines regarding the choice of modality and timing of thoracic imaging in children with CF are lagging behind these rapid technological advances. The continued progress of personalised medicine in the form of CFTR modulators will promote the emergence of personalised radiological diagnostics.
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Affiliation(s)
- Patrick W. O’Regan
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
| | - Niamh E. Stevens
- Department of Surgery, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Niamh Logan
- Department of Medicine, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - David J. Ryan
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
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Cè M, Oliva G, Rabaiotti FL, Macrì L, Zollo S, Aquila A, Cellina M. Portable Dynamic Chest Radiography: Literature Review and Potential Bedside Applications. Med Sci (Basel) 2024; 12:10. [PMID: 38390860 PMCID: PMC10885043 DOI: 10.3390/medsci12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024] Open
Abstract
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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Affiliation(s)
- Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Giancarlo Oliva
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy; (G.O.); (M.C.)
| | - Francesca Lucrezia Rabaiotti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Laura Macrì
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Sharon Zollo
- Konica Minolta Business Solutions Europe GmbH, Capellalaan 65, 2132 JL Hoofddorp, The Netherlands;
| | - Alessandro Aquila
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (F.L.R.); (L.M.); (A.A.)
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milan, Italy; (G.O.); (M.C.)
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Nakamura H, Hirai T, Kurosawa H, Hamada K, Matsunaga K, Shimizu K, Konno S, Muro S, Fukunaga K, Nakano Y, Kuwahira I, Hanaoka M. Current advances in pulmonary functional imaging. Respir Investig 2024; 62:49-65. [PMID: 37948969 DOI: 10.1016/j.resinv.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance imaging (MRI), in addition to modalities including dynamic chest radiography, scintigraphy, positron emission tomography (PET), ultrasound, and electrical impedance tomography (EIT). In this review, an overview of current functional imaging techniques is provided for each modality. Advances in chest CT have allowed for the analysis of local volume changes and small airway disease in addition to emphysema, using the Jacobian determinant and parametric response mapping with inspiratory and expiratory images. Airway analysis can reveal characteristics of airway lesions in chronic obstructive pulmonary disease (COPD) and bronchial asthma, and the contribution of dysanapsis to obstructive diseases. Chest CT is also employed to measure pulmonary blood vessels, interstitial lung abnormalities, and mediastinal and chest wall components including skeletal muscle and bone. Dynamic CT can visualize lung deformation in respective portions. Pulmonary MRI has been developed for the estimation of lung ventilation and perfusion, mainly using hyperpolarized 129Xe. Oxygen-enhanced and proton-based MRI, without a polarizer, has potential clinical applications. Dynamic chest radiography is gaining traction in Japan for ventilation and perfusion analysis. Single photon emission CT can be used to assess ventilation-perfusion (V˙/Q˙) mismatch in pulmonary vascular diseases and COPD. PET/CT V˙/Q˙ imaging has also been demonstrated using "Galligas". Both ultrasound and EIT can detect pulmonary edema caused by acute respiratory distress syndrome. Familiarity with these functional imaging techniques will enable clinicians to utilize these systems in clinical practice.
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Affiliation(s)
- Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Kurosawa
- Center for Environmental Conservation and Research Safety and Department of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Ichiro Kuwahira
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Okamoto H, Miyatake H, Kodama M, Matsubayashi J, Matsutani N, Fujino K, Tsujita Y, Shiomi N, Nakagawa Y. Discriminative Ability of Dynamic Chest Radiography to Identify Left Ventricular Dysfunction. Circ J 2023; 88:159-167. [PMID: 38030239 DOI: 10.1253/circj.cj-23-0429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Dynamic chest radiography (DCR) produces sequential radiographs within a short examination time. It is also inexpensive and only uses a low dose of radiation. Because of the lack of reports of evaluating cardiac function using DCR in humans, we investigated its discriminative ability for left ventricular (LV) dysfunction in a study cohort.Methods and Results: We analyzed the DCR pixel values of 4 circular regions of interest (ROIs) in the hearts of 61 patients with cardiovascular disease and 10 healthy volunteers. We evaluated the relationship between changes in pixel value in the heart and the LV ejection fraction (LVEF) by echocardiography. We constructed receiver operating characteristic (ROC) curves to evaluate whether the percent change in pixel value (%∆pixel value) could be used to identify patients with reduced LVEF. A total of 21 patients had reduced LVEF (LVEF <50%), and 40 had preserved LVEF (LVEF ≥50%). The correlation between LVEF and %∆pixel value in each ROI was significant, and the area under the ROC curve of the %∆pixel values for identifying patients with reduced LVEF was satisfactory (0.808-0.827) in 3 ROIs where the entire circular area was within the cardiac shadow. CONCLUSIONS LV dysfunction can be detected by changes in the pixel value on DCR.
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Affiliation(s)
- Hiroki Okamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science
| | - Hidemitsu Miyatake
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science
| | - Misato Kodama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science
| | - Jun Matsubayashi
- Center for Clinical Research and Advanced Medicine, Shiga University of Medical Science
| | | | - Kazunori Fujino
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science
| | - Yasuyuki Tsujita
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science
| | - Naoto Shiomi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science
| | - Yoshihisa Nakagawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science
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Fyles F, FitzMaurice TS, Robinson RE, Bedi R, Burhan H, Walshaw MJ. Dynamic chest radiography: a state-of-the-art review. Insights Imaging 2023; 14:107. [PMID: 37332064 DOI: 10.1186/s13244-023-01451-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/14/2023] [Indexed: 06/20/2023] Open
Abstract
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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Affiliation(s)
- Fred Fyles
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S FitzMaurice
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Ryan E Robinson
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ram Bedi
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hassan Burhan
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Martin J Walshaw
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Hiraiwa H, Sakamoto G, Ito R, Koyama Y, Kazama S, Kimura Y, Kondo T, Morimoto R, Okumura T, Murohara T. Dynamic chest radiography as a novel minimally invasive hemodynamic imaging method in patients with heart failure. Eur J Radiol 2023; 161:110729. [PMID: 36804311 DOI: 10.1016/j.ejrad.2023.110729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Dynamic chest radiography allows for non-invasive cardiopulmonary blood flow assessment. However, data on its use for heart failure hemodynamic assessment are scarce. We utilized dynamic chest radiography to estimate heart failure hemodynamics. METHOD Twenty heart failure patients (median age, 67 years; 17 men) underwent dynamic chest radiography and right heart catheterization. The analyzed images were 16-bit images (grayscale range: 0-65,535). Right atrial, right pulmonary artery, and left ventricular apex pixel values (average of the grayscale values of all pixels within a region of interest) were measured. The correlations of the minimum, maximum, mean, amount of change, and rate of change in pixel values with right atrial pressure, pulmonary artery pressure, pulmonary artery wedge pressure, and cardiac index were analyzed. RESULTS The mean right atrial pixel value and mean right atrial pressure (R = -0.576, P = 0.008), mean right pulmonary artery pixel value and mean pulmonary artery pressure (R = -0.546, P = 0.013), and left ventricular apex pixel value change rate and mean pulmonary artery wedge pressure (R = -0.664, P = 0.001) or cardiac index (R = 0.606, P = 0.005) were correlated. The left ventricular apex pixel value change rate identified low cardiac index (area under the curve, 0.792; 95% confidence interval, 0.590-0.993; P = 0.031) and low cardiac index with high pulmonary artery wedge pressure (area under the curve, 0.902; 95% confidence interval, 0.000-1.000; P = 0.030). CONCLUSIONS Dynamic chest radiography is a minimally invasive tool for heart failure hemodynamic assessment.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Gaku Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Ito
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuichiro Koyama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Hino T, Tsunomori A, Hata A, Hida T, Yamada Y, Ueyama M, Yoneyama T, Kurosaki A, Kamitani T, Ishigami K, Fukumoto T, Kudoh S, Hatabu H. Vector-field dynamic x-ray (VF-DXR) using optical flow method in patients with chronic obstructive pulmonary disease. Eur Radiol Exp 2022; 6:4. [PMID: 35099604 PMCID: PMC8802288 DOI: 10.1186/s41747-021-00254-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We assessed the difference in lung motion during inspiration/expiration between chronic obstructive pulmonary disease (COPD) patients and healthy volunteers using vector-field dynamic x-ray (VF-DXR) with optical flow method (OFM). METHODS We enrolled 36 COPD patients and 47 healthy volunteers, classified according to pulmonary function into: normal, COPD mild, and COPD severe. Contrast gradient was obtained from sequential dynamic x-ray (DXR) and converted to motion vector using OFM. VF-DXR images were created by projection of the vertical component of lung motion vectors onto DXR images. The maximum magnitude of lung motion vectors in tidal inspiration/expiration, forced inspiration/expiration were selected and defined as lung motion velocity (LMV). Correlations between LMV with demographics and pulmonary function and differences in LMV between COPD patients and healthy volunteers were investigated. RESULTS Negative correlations were confirmed between LMV and % forced expiratory volume in one second (%FEV1) in the tidal inspiration in the right lung (Spearman's rank correlation coefficient, rs = -0.47, p < 0.001) and the left lung (rs = -0.32, p = 0.033). A positive correlation between LMV and %FEV1 in the tidal expiration was observed only in the right lung (rs = 0.25, p = 0.024). LMVs among normal, COPD mild and COPD severe groups were different in the tidal respiration. COPD mild group showed a significantly larger magnitude of LMV compared with the normal group. CONCLUSIONS In the tidal inspiration, the lung parenchyma moved faster in COPD patients compared with healthy volunteers. VF-DXR was feasible for the assessment of lung parenchyma using LMV.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Akinori Tsunomori
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Inc., 2970 Ishikawa-machi, Hachioji-shi, Tokyo, Japan
| | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, Japan
| | - Tsutomu Yoneyama
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Inc., 2970 Ishikawa-machi, Hachioji-shi, Tokyo, Japan
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Takenori Fukumoto
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Inc., 2970 Ishikawa-machi, Hachioji-shi, Tokyo, Japan
| | - Shoji Kudoh
- Japan Anti-Tuberculosis Association, 1-3-12 Kanda-Misakicho, Chiyoda-ku, Tokyo, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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FitzMaurice TS, McCann C, Nazareth D, Shaw M, McNamara PS, Walshaw MJ. Measuring the effect of elexacaftor/tezacaftor/ivacaftor combination therapy on the respiratory pump in people with CF using dynamic chest radiography. J Cyst Fibros 2022; 21:1036-1041. [DOI: 10.1016/j.jcf.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
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10
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FitzMaurice TS, McCann C, Nazareth DS, Walshaw MJ. Characterisation of hemidiaphragm dysfunction using dynamic chest radiography: a pilot study. ERJ Open Res 2021; 8:00343-2021. [PMID: 35211619 PMCID: PMC8862633 DOI: 10.1183/23120541.00343-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Dynamic chest radiography (DCR) is a novel real-time digital fluoroscopic imaging system that produces clear, wide field-of-view diagnostic images of the thorax and diaphragm in motion, alongside novel metrics on moving structures within the thoracic cavity. We describe the use of DCR in the measurement of diaphragm motion in a pilot series of cases of suspected diaphragm dysfunction. Methods We studied 21 patients referred for assessment of diaphragm function due to suspicious clinical symptoms or imaging (breathlessness, orthopnoea, reduced exercise tolerance and/or an elevated hemidiaphragm on plain chest radiograph). All underwent DCR with voluntary sniff manoeuvres. Results Paradoxical motion on sniffing was observed in 14 patients, and confirmed in six who also underwent fluoroscopy or ultrasound. In four patients, DCR showed reduced hemidiaphragm excursion, but no paradoxical motion; in three, normal bilateral diaphragm motion was demonstrated. DCR was quick to perform, and well tolerated in all cases and with no adverse events reported. DCR was achieved in ∼5 min per patient, with images available to view by the clinician immediately within the clinical setting. Conclusion DCR is a rapid, well-tolerated and straightforward chest radiography technique that warrants further investigation in the assessment of diaphragm dysfunction. Dynamic chest radiography is a rapid, well-tolerated and straightforward chest radiography technique that warrants further investigation in the assessment of diaphragm dysfunctionhttps://bit.ly/3HFriWk
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Tanaka R, Kasahara K, Ohkura N, Matsumoto I, Tamura M, Takata M, Inoue D, Izumozaki A, Horii J, Matsuura Y, Sanada S. [Paradigm Shift in Respiratory Diagnosis: Current Status and Future Prospects of Dynamic Chest Radiography]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:1279-1287. [PMID: 34803108 DOI: 10.6009/jjrt.2021_jsrt_77.11.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dynamic chest radiography (DCR) is a flat-panel detector (FPD) -based functional X-ray imaging, which is performed as an additional examination in chest radiography. The large field of view of FPDs permits real-time observation of motion/kinetic findings on the entire lungs, right and left diaphragm, ribs, and chest wall; heart wall motions; respiratory changes in lung density; and diameter of the intrathoracic trachea. Since the dynamic FPDs had been developed in the early 2000s, we focused on the potential of dynamic FPDs for functional X-ray imaging and have launched a research project for the development of an imaging protocol and digital image-processing techniques for the DCR. The quantitative analysis of motion/kinetic findings is helpful for a better understanding of pulmonary function, because the interpretation of dynamic chest radiographs is challenging and time-consuming for radiologists, pulmonologists, and surgeons. Recent clinical studies have demonstrated the usefulness of DCR combined with the digital image processing techniques for the evaluation of pulmonary function and circulation. Especially, there is a major concern in color-mapping images based on dynamic changes in radiographic lung density, where pulmonary impairments can be detected as color defects, even without the use of contrast media or radioactive medicine. Dynamic chest radiography is now commercially available for the use in general X-ray room and therefore can be deployed as a simple and rapid means of functional imaging in both routine and emergency medicine. This review article describes the current status and future prospects of DCR, which might bring a paradigm shift in respiratory diagnosis.
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Affiliation(s)
- Rie Tanaka
- College of Medical, Pharmaceutical & Health Sciences, Kanazawa University
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital
| | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital
| | | | | | | | - Dai Inoue
- Department of Radiology, Kanazawa University Hospital
| | | | - Junsei Horii
- Division of Radiology, Kanazawa University Hospital
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12
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Bordoni B, Escher AR. Functional evaluation of the diaphragm with a noninvasive test. J Osteopath Med 2021; 121:835-842. [PMID: 34523291 DOI: 10.1515/jom-2021-0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022]
Abstract
Cardiac surgery with median sternotomy causes iatrogenic damage to the function of the diaphragm muscle that is both temporary and permanent. Myocardial infarction itself causes diaphragmatic genetic alterations, which lead the muscle to nonphysiological adaptation. The respiratory muscle area plays several roles in maintaining both physical and mental health, as well as in maximizing recovery after a cardiac event. The evaluation of the diaphragm is a fundamental step in the therapeutic process, including the use of instruments such as ultrasound, magnetic resonance imaging (MRI), and computed axial tomography (CT). This article reviews the neurophysiological relationships of the diaphragm muscle and the symptoms of diaphragmatic contractile dysfunction. The authors discuss a scientific basis for the use of a new noninstrumental diaphragmatic test in the hope of stimulating research.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific, Milan, Italy
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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13
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Tanaka R, Matsumoto I, Tamura M, Takata M, Yoshida S, Saito D, Tanaka Y, Inoue D, Ohkura N, Kasahara K. Dynamic chest radiography: clinical validation of ventilation and perfusion metrics derived from changes in radiographic lung density compared to nuclear medicine imaging. Quant Imaging Med Surg 2021; 11:4016-4027. [PMID: 34476186 DOI: 10.21037/qims-20-1217] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
Background Dynamic chest radiography (DCR) is a type of non-contrast-enhanced functional lung imaging with a dynamic flat-panel detector (FPD). This study aimed to assess the clinical significance of ventilation and perfusion metrics derived from changes in radiographic lung density on DCR in comparison to nuclear medicine imaging-derived metrics. Methods DCR images of 42 lung cancer patients were sequentially obtained during respiration using a dynamic FPD imaging system. For each subdivided lung region, the maximum change in the averaged pixel value (Δmax), i.e., lung density, due to respiration and cardiac function was calculated, and the percentage of Δmax relative to the total of all lung regions (Δmax%) was computed for ventilation and perfusion, respectively. The Δmax% was compared to the accumulation of radioactive agents such as Tc-99m gas and Tc-99m macro-aggregated albumin (radioactive agents%) on ventilation and perfusion scans in the subdivided lung regions, by Spearman's correlation coefficient (r) and the Dice similarity coefficients (DSC). To facilitate visual evaluation, Δmax% was visualized as a color scaling, where larger Δmax values were indicated by higher color intensities. Results We found a moderate correlation between Δmax% and radioactive agents% on ventilation and perfusion scans, with perfusion metrics (r=0.57, P<0.001) showing a higher correlation than ventilation metrics (r=0.53, P<0.001). We also found a good or strong correlation (r≥0.5) in 80.9% (34/42) of patients for perfusion metrics (r=0.60±0.16) and in 52.4% (22/42) of patients for ventilation metrics (r=0.53±0.16). DSC indicated a moderate correlation for both metrics. Decreased pulmonary function was observed in the form of reduced color intensities on color-mapping images. Conclusions DCR-derived ventilation and perfusion metrics correlated reasonably well with nuclear medicine imaging findings in lung subdivisions, suggesting that DCR could provide useful information on pulmonary function without the use of radioactive contrast agents.
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Affiliation(s)
- Rie Tanaka
- College of Medical, Pharmaceutical & Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masaya Tamura
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Munehisa Takata
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shuhei Yoshida
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daisuke Saito
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yusuke Tanaka
- Department of Thoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Noriyuki Ohkura
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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Molnár V, Molnár A, Lakner Z, Tárnoki DL, Tárnoki ÁD, Jokkel Z, Szabó H, Dienes A, Angyal E, Németh F, Kunos L, Tamás L. Examination of the diaphragm in obstructive sleep apnea using ultrasound imaging. Sleep Breath 2021; 26:1333-1339. [PMID: 34478056 PMCID: PMC9418095 DOI: 10.1007/s11325-021-02472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/31/2021] [Accepted: 08/09/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to analyze the effect of obstructive sleep apnea (OSA) on the ultrasound (US) features of the diaphragm and to determine if diaphragmatic US may be a useful screening tool for patients with possible OSA. METHODS Patients complaining of snoring were prospectively enrolled for overnight polygraphy using the ApneaLink Air device. Thickness and motion of the diaphragm during tidal and deep inspiration were measured. Logistic regression was used to assess parameters of the diaphragm associated with OSA. RESULTS Of 100 patients, 64 were defined as having OSA. Thicknesses of the left and right hemidiaphragms were significantly different between OSA and control groups. Using a combination of diaphragmatic dimensions, diaphragm dilation, age, sex, and BMI, we developed an algorithm that predicted the presence of OSA with 91% sensitivity and 81% specificity. CONCLUSION A combination of anthropometric measurements, demographic factors, and US imaging may be useful for screening patients for possible OSA. These findings need to be confirmed in larger sample sizes in different clinical settings.
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Affiliation(s)
- Viktória Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
| | - András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary.
| | - Zoltán Lakner
- Faculty of Food Science, Szent István University, Budapest, Hungary
| | | | | | - Zsófia Jokkel
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Helga Szabó
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - András Dienes
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Emese Angyal
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
| | - Fruzsina Németh
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
| | | | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Semmelweis University, Szigony u. 36, H-1083, Budapest, Hungary
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15
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Ueyama M, Hashimoto S, Takeda A, Maruguchi N, Yamamoto R, Matsumura K, Nakamura S, Terada S, Inao T, Kaji Y, Yasuda T, Hajiro T, Tanaka E, Taguchi Y, Noma S. Prediction of forced vital capacity with dynamic chest radiography in interstitial lung disease. Eur J Radiol 2021; 142:109866. [PMID: 34365304 DOI: 10.1016/j.ejrad.2021.109866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The pulmonary function test (PFT) has played an essential role in diagnosing and managing interstitial lung disease (ILD) but has its contraindications and difficult conditions to perform. Therefore, the present study aimed to evaluate dynamic chest radiography (DCR) ability to predict forced vital capacity (FVC) and other PFT parameters of ILD patients. METHOD The prospective observational study included 97 patients who underwent DCR at Tenri Hospital (Tenri, Japan) between June 2019 and April 2020. Twenty-five patients with stable disease status underwent DCR twice to evaluate test-retest reliability using the intraclass correlation coefficient. From the lung field areas measured by DCR, lung volumes at maximum inspiration (V.ins) and expiration (V.exp) were estimated. Correlation coefficients between the measured values of DCR and PFT parameters were calculated. Multilinear models for predicting FVC and other PFT parameters were developed. RESULTS Intraclass correlation coefficients between first and second measurements of V.ins and V.exp were 0.94 (95% CI: 0.89-0.97, p < 0.001) and 0.88 (95% CI: 0.78-0.94, p < 0.001), respectively. The correlation coefficient between V.ins and FVC was 0.86 (95% CI: 0.79-0.90, p < 0.001). A multilinear model for predicting FVC was developed using V.ins, V.exp, age, sex, and body mass index as predictor variables, wherein the adjusted coefficient of determination was 0.814. CONCLUSIONS Lung volumes measured by DCR correlated with the lung function of ILD patients. Prediction models with high predictive power and internal validity were developed, suggesting that DCR can predict FVC and other PFT parameters of ILD patients.
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Affiliation(s)
- Masakuni Ueyama
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan.
| | - Seishu Hashimoto
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Atsushi Takeda
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Naoto Maruguchi
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Ryo Yamamoto
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Kazuki Matsumura
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Satoshi Nakamura
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Satoru Terada
- Department of Respiratory Medicine, Kyoto University, Yoshida-honmachi Sakyo-ku Kyoto-shi, Kyoto 606-8501, Japan
| | - Takashi Inao
- Department of Respiratory Medicine, Shinko Hospital, 1-4-47 Wakinohama-cho Chuo-ku Kobe-shi, Hyogo 651-0072, Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Takehiro Yasuda
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Takashi Hajiro
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Eisaku Tanaka
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
| | - Satoshi Noma
- Department of Radiology, Tenri Hospital, 200 Mishima-cho Tenri-shi, Nara 632-8552, Japan
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16
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Hino T, Tsunomori A, Fukumoto T, Hata A, Ueyama M, Kurosaki A, Yoneyama T, Nagatsuka S, Kudoh S, Hatabu H. Vector-Field dynamic X-ray (VF-DXR) using Optical Flow Method. Br J Radiol 2021; 95:20201210. [PMID: 34233474 DOI: 10.1259/bjr.20201210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To explore the feasibility of Vector-Field DXR (VF-DXR) using optical flow method (OFM). METHODS Five healthy volunteers and five COPD patients were studied. DXR was performed in the standing position using a prototype X-ray system (Konica Minolta Inc., Tokyo, Japan). During the examination, participants took several tidal breaths and one forced breath. DXR image file was converted to the videos with different frames per second (fps): 15 fps, 7.5 fps, five fps, three fps, and 1.5 fps. Pixel-value gradient was calculated by the serial change of pixel value, which was subsequently converted mathematically to motion vector using OFM. Color-coding map and vector projection into horizontal and vertical components were also tested. RESULTS Dynamic motion of lung and thorax was clearly visualized using VF-DXR with an optimal frame rate of 5 fps. Color-coding map and vector projection into horizontal and vertical components were also presented. VF-DXR technique was also applied in COPD patients. CONCLUSION The feasibility of VF-DXR was demonstrated with small number of healthy subjects and COPD patients. ADVANCES IN KNOWLEDGE A new Vector-Field Dynamic X-ray (VF-DXR) technique is feasible for dynamic visualization of lung, diaphragms, thoracic cage, and cardiac contour.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akinori Tsunomori
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Hachioji-shi, Tokyo, Japan
| | - Takenori Fukumoto
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Hachioji-shi, Tokyo, Japan
| | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Tsutomu Yoneyama
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Hachioji-shi, Tokyo, Japan
| | - Sumiya Nagatsuka
- R&D Promotion Division, Healthcare Business Headquarters, Konica Minolta, Hachioji-shi, Tokyo, Japan
| | - Shoji Kudoh
- Japan Anti-Tuberculosis Association, Chiyoda-ku, Tokyo, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Shibuya Y, Machida H, Yoshiike S, Suda K, Tanaka R, Fujiwara M, Yokoyama K, Kondo H. Pulmonary artery aneurysm diagnosed by dynamic digital chest radiography. Ann Thorac Surg 2021; 113:e87-e90. [PMID: 34022216 DOI: 10.1016/j.athoracsur.2021.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 11/01/2022]
Abstract
Pulmonary artery aneurysms (PAAs) are rare, but clinically important because their rupture can cause sudden death. We present the first case of an asymptomatic patient with an unruptured PAA that was successfully diagnosed by dynamic digital chest radiography (DDCR) and was treated surgically. DDCR is a state-of-the-art temporally resolved radiographic technique that offers high-quality fluoroscopy-like images at a low radiation dose. Although noncontrast chest computed tomography (CT) revealed only a nonspecific nodule, DDCR delineated this lesion as a pulsatile nodule synchronized with cardiac pulsations, establishing the diagnosis of PAA. This diagnosis was confirmed by CT pulmonary angiography and surgery.
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Affiliation(s)
- Yukimi Shibuya
- Department of Thoracic and Thyroid Surgery, Faculty of Medicine, Kyorin University.
| | | | - Shinya Yoshiike
- Department of Pathology, Faculty of Medicine, Kyorin University
| | - Kazuharu Suda
- Department of Thoracic and Thyroid Surgery, Faculty of Medicine, Kyorin University
| | - Ryota Tanaka
- Department of Thoracic and Thyroid Surgery, Faculty of Medicine, Kyorin University
| | | | | | - Haruhiko Kondo
- Department of Thoracic and Thyroid Surgery, Faculty of Medicine, Kyorin University
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18
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Diaphragmatic thickness and excursion by lung ultrasound in pediatric chronic pulmonary diseases. J Ultrasound 2021; 25:97-102. [PMID: 33604840 PMCID: PMC8964846 DOI: 10.1007/s40477-021-00570-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Many patients with chronic pulmonary diseases, such as interstitial lung disease, cystic fibrosis, and non-cystic fibrosis bronchiectasis, suffer from dyspnea and exercise intolerance. Reduced lung compliance is the main cause of the patients' dyspnea, but weak respiratory muscles could be an additional factor. The diaphragm is considered the major respiratory muscle. Our study aimed to detect diaphragmatic thickness and excursion by ultrasound in pediatric patients with chronic pulmonary diseases to assess respiratory muscle weakness in these patients. METHODS A case-control study was conducted on 130 patients with pediatric chronic pulmonary diseases (childhood interstitial lung diseases, cystic fibrosis, and non-cystic fibrosis bronchiectasis) and 100 control subjects. Ultrasound was used to detect diaphragmatic excursion and thickness, which were correlated with the severity of the disease, both clinically and functionally. RESULTS The right and left diaphragmatic excursions were significantly lower in the patients (19.469 ± 9.984 and 18.5 ± 10.131, respectively) than in the control subjects (29.6 ± 14.131 and 25.6 ± 12.827, respectively) (p values of 0.002 and 0.019). In contrast, the difference in the right and left diaphragmatic thicknesses between the patients and the controls was statistically insignificant (p values of 0.884 and 0.344). The left diaphragmatic excursion was positively correlated with the patients' age and weight, while both the right and the left diaphragmatic excursion significantly correlated with the patients' height, FEV1/FVC ratio, and heart rate. CONCLUSION The diaphragmatic excursion is lower in children and adolescents with chronic pulmonary diseases than in healthy control subjects. The diaphragmatic excursion is positively correlated with patients' age, weight, height, FEV1/FVC ratio, and heart rate.
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Hata A, Yamada Y, Tanaka R, Nishino M, Hida T, Hino T, Ueyama M, Yanagawa M, Kamitani T, Kurosaki A, Sanada S, Jinzaki M, Ishigami K, Tomiyama N, Honda H, Kudoh S, Hatabu H. Dynamic Chest X-Ray Using a Flat-Panel Detector System: Technique and Applications. Korean J Radiol 2020; 22:634-651. [PMID: 33289365 PMCID: PMC8005348 DOI: 10.3348/kjr.2020.1136] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD). This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.
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Affiliation(s)
- Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Rie Tanaka
- Department of Radiological Technology, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Masahiro Yanagawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Shigeru Sanada
- Clinical Engineering, Komatsu University, Ishikawa, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoji Kudoh
- Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Hino T, Hata A, Hida T, Yamada Y, Ueyama M, Araki T, Kamitani T, Nishino M, Kurosaki A, Jinzaki M, Ishigami K, Honda H, Hatabu H, Kudoh S. Projected lung areas using dynamic X-ray (DXR). Eur J Radiol Open 2020; 7:100263. [PMID: 32953949 PMCID: PMC7486627 DOI: 10.1016/j.ejro.2020.100263] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
The right projected lung area (PLA) was significantly larger than left one. PLA had correlation with height, weight, BMI, vital capacity (VC), and forced expiratory volume in one second (FEV1). Multivariate analysis showed that body mass index (BMI), sex and VC were considered independent correlation factors, respectively.
Background Dynamic X-ray (DXR) provides images of multiple phases of breath with less radiation exposure than CT. The exact images at end-inspiratory or end-expiratory phases can be chosen accurately. Purpose To investigate the correlation of the projected lung area (PLA) by dynamic chest X-ray with pulmonary functions. Material and Methods One hundred sixty-two healthy volunteers who received medical check-ups for health screening were included in this study. All subjects underwent DXR in both posteroanterior (PA) and lateral views and pulmonary function tests on the same day. All the volunteers took several tidal breaths before one forced breath as instructed. The outlines of lungs were contoured manually on the workstation with reference to the motion of diaphragm and the graph of pixel values. The PLAs were calculated automatically, and correlations with pulmonary functions and demographic data were analyzed statistically. Results The PLAs have correlation with physical characteristics, including height, weight and BMI, and pulmonary functions such as vital capacity (VC) and forced expiratory volume in one second (FEV1). VC and FEV1 revealed moderate correlation with the PLAs of PA view in forced inspiratory phase (VC: right, r = 0.65; left, r = 0.69. FEV1: right, r = 0.54; left, r = 0.59). Multivariate analysis showed that body mass index (BMI), sex and VC were considered independent correlation factors, respectively. Conclusion PLA showed statistically significant correlation with pulmonary functions. Our results indicate DXR has a possibility to serve as an alternate method for pulmonary function tests in subjects requiring contact inhibition including patients with suspected or confirmed covid-19.
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Key Words
- %FEV1, percent predicted FEV1
- %VC, percent vital capacity
- BMI, body mass index
- COPD, chronic obstructive pulmonary disease
- Chest radiograph
- DXR, dynamic X-ray
- FEV1%, forced expiratory volume percent in one second divided by FVC
- FEV1, forced expiratory volume in one second
- FPD, flat-panel detector
- FVC, forced vital capacity
- Health screening cohort
- IPF, idiopathic pulmonary fibrosis
- PA, posteroanterior
- PFTs, pulmonary function tests
- PLA, projected lung area
- Projected lung area
- Pulmonary function
- TLC, total lung capacity
- TV, tidal volume
- VC, vital capacity
- dynamic X-ray
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
- Corresponding author at: Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, Japan
| | - Tetsuro Araki
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Atsuko Kurosaki
- Department of Diagnostic Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, 3-1-24 Matsuyama, Kiyose, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Shoji Kudoh
- Japan Anti-Tuberculosis Association, 1-3-12 Kanda-Misakicho, Chiyoda-ku, Tokyo, Japan
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21
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FitzMaurice TS, McNamara PS, Nazareth D, McCann C, Bedi R, Shaw M, Walshaw M. Utility and validity of dynamic chest radiography in cystic fibrosis (dynamic CF): an observational, non-controlled, non-randomised, single-centre, prospective study. BMJ Open Respir Res 2020; 7:7/1/e000569. [PMID: 32217535 PMCID: PMC7206905 DOI: 10.1136/bmjresp-2020-000569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Dynamic chest radiography (DCR) uses novel, low-dose radiographic technology to capture images of the thoracic cavity while in motion. Pulmonary function testing is important in cystic fibrosis (CF). The tolerability, rapid acquisition and lower radiation and cost compared with CT imaging may make DCR a useful adjunct to current standards of care. METHODS AND ANALYSIS This is an observational, non-controlled, non-randomised, single-centre, prospective study. This study is conducted at the Liverpool Heart and Chest Hospital (LHCH) adult CF unit. Participants are adults with CF. This study reviews DCR taken during routine CF Annual Review (n=150), validates DCR-derived lung volumes against whole body plethysmography (n=20) and examines DCR at the start and end of pulmonary exacerbations of CF (n=20). The primary objectives of this study are to examine if DCR provides lung function information that correlates with PFT, and lung volumes that correlate whole body plethysmography. ETHICS AND DISSEMINATION This study has received the following approvals: HRA REC (11 December 2019) and LHCH R&I (11 October 2019). Results are made available to people with CF, the funders and other researchers. Processed, anonymised data are available from the research team on request. TRIAL REGISTRATION NUMBER ISRCTN 64994816.
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Affiliation(s)
- Thomas Simon FitzMaurice
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK .,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paul Stephen McNamara
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Institute in the Park, Alder Hey Children's Hospital, Liverpool, UK
| | - Dilip Nazareth
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Caroline McCann
- Department of Radiology, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Ram Bedi
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Matthew Shaw
- Research Department, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Martin Walshaw
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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22
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Zhang J, Su Q, Loudon WG, Lee KL, Luo J, Dethlefs BA, Li SC. Breathing Signature as Vitality Score Index Created by Exercises of Qigong: Implications of Artificial Intelligence Tools Used in Traditional Chinese Medicine. J Funct Morphol Kinesiol 2019; 4:71. [PMID: 31853512 PMCID: PMC6919646 DOI: 10.3390/jfmk4040071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rising concerns about the short- and long-term detrimental consequences of administration of conventional pharmacopeia are fueling the search for alternative, complementary, personalized, and comprehensive approaches to human healthcare. Qigong, a form of Traditional Chinese Medicine, represents a viable alternative approach. Here, we started with the practical, philosophical, and psychological background of Ki (in Japanese) or Qi (in Chinese) and their relationship to Qigong theory and clinical application. Noting the drawbacks of the current state of Qigong clinic, herein we propose that to manage the unique aspects of the Eastern 'non-linearity' and 'holistic' approach, it needs to be integrated with the Western "linearity" "one-direction" approach. This is done through developing the concepts of "Qigong breathing signatures," which can define our life breathing patterns associated with diseases using machine learning technology. We predict that this can be achieved by establishing an artificial intelligence (AI)-Medicine training camp of databases, which will integrate Qigong-like breathing patterns with different pathologies unique to individuals. Such an integrated connection will allow the AI-Medicine algorithm to identify breathing patterns and guide medical intervention. This unique view of potentially connecting Eastern Medicine and Western Technology can further add a novel insight to our current understanding of both Western and Eastern medicine, thereby establishing a vitality score index (VSI) that can predict the outcomes of lifestyle behaviors and medical conditions.
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Affiliation(s)
- Junjie Zhang
- School of Physical Training and Physical Therapy, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen 518060, China
| | - Qingning Su
- Center of Bioengineering, School of Medicine, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen 518060, China
| | - William G. Loudon
- Neuroscience Institute, Children’s Hospital of Orange County, Gamma Knife Center of Southern California, Department of Neurosurgery, University of California-Irvine School of Medicine, Orange, CA 92612, USA
| | - Katherine L. Lee
- School of Social Ecology, University of California-Irvine, 5300 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7050, USA
| | - Jane Luo
- AB Sciex, Inc., Danaher Corporation, 250 South Kraemer Boulevard, Brea, CA 92821-6232, USA
| | - Brent A. Dethlefs
- CHOC Children’s Research Institute, Children’s Hospital of Orange County (CHOC), 1201 W. La Veta Ave., Orange, CA 92868-3874, USA
| | - Shengwen Calvin Li
- Neuro-Oncology and Stem Cell Research Laboratory (NSCL), CHOC Children’s Research Institute (CCRI), Children’s Hospital of Orange County (CHOC), 1201 W. La Veta Ave., Orange, CA 92868-3874, USA
- Department of Neurology, University of California-Irvine (UCI) School of Medicine, 200 S Manchester Ave Ste 206, Orange, CA 92868, USA
- Correspondence: ; Tel.: +1-714-509-4964; Fax: +1-714-509-4318
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