Dynamic chest radiography promising for assessment of diaphragm dysfunction: Study
Liverpool, UK: A recent study revealed dynamic chest radiography (DCR) to be a promising technique for the diagnosis of patients with breathing symptoms related to diaphragm dysfunction. The study was published in European Respiratory Journal (ERJ) Open Research on February 21, 2022.
"DCR is a well-tolerated, rapid and straightforward chest radiography technique that warrants further research in the assessment of diaphragm dysfunction," Thomas Simon FitzMaurice, University of Liverpool, Liverpool, UK, and colleagues wrote in their study.
Dynamic chest radiography is shown to be a novel real-time digital fluoroscopic imaging system that produces clear, wide field-of-view diagnostic images of the diaphragm and thorax in motion, alongside novel metrics on moving structures within the thoracic cavity. Considering this, the researchers' team described DCR use in the measurement of diaphragm motion in a pilot series of cases of suspected diaphragm dysfunction.
For this purpose, the authors studied 21 patients referred for assessment of diaphragm function due to suspicious clinical symptoms or imaging ( orthopnoea, reduced exercise tolerance, breathlessness, and/or an elevated hemidiaphragm on plain chest radiograph). All underwent DCR with voluntary sniff maneuvers.
Key findings of the study are as follows:
- 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.
To conclude, DCR proved quick and straightforward to perform. It easily produces interpretable metrics on diaphragm and chest wall motion that warrant further study alongside established diagnostic tools such as traditional fluoroscopy and ultrasound. Larger studies are warranted based on these initial results, the authors wrote.
Reference:
Characterisation of hemidiaphragm dysfunction using dynamic chest radiography: a pilot study Thomas Simon FitzMaurice, Caroline McCann, Dilip S. Nazareth, Martin J. Walshaw ERJ Open Research Jan 2022, 8 (1) 00343-2021; DOI: 10.1183/23120541.00343-2021
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