Chest radiography effective as pulmonary function tests for COPD screening: Study
A recent study published in the journal of Radiology showed that dynamic chest radiography (DCR) may serve as an effective alternative to traditional pulmonary function tests (PFTs) for screening chronic obstructive pulmonary disease (COPD). This study from a single medical center investigated the diagnostic potential of DCR in a cohort of more than 500 participants, which demonstrated promising correlations with standard lung function measures.
Pulmonary function tests are widely recognized as the clinical standard for diagnosing COPD, a progressive respiratory disease affecting millions worldwide. However, their complexity and limited accessibility can pose challenges, particularly in community and rural healthcare settings. DCR, which captures real-time lung motion and function through dynamic imaging, offers a potential solution with minimal radiation exposure.
In this prospective observational study, 553 participants (191 with diagnosed COPD and 362 control subjects) underwent both DCR and PFTs between November 2022 and July 2024. This research analyzed how various DCR parameters, like the rate of change in projected lung area (ΔPLA) during deep breathing, correlated with established PFT measures like forced expiratory volume in 1 second (FEV1) and the FEV1/forced vital capacity ratio.
The study found the combined bilateral ΔPLA showed strong positive correlations with FEV1 percent predicted (r = 0.650) and the FEV1/FVC ratio (r = 0.638). Diagnostic performance was further evaluated using receiver operating characteristic analysis, which revealed that bilateral ΔPLA alone achieved an area under the curve (AUC) of 0.78 in the internal test set, a level considered robust for clinical screening purposes.
To enhance predictive accuracy, this research applied advanced statistical modeling, including LASSO feature selection and multivariable logistic regression. 3 DCR parameters were incorporated into a dedicated predictive model, which achieved an AUC of 0.82 in testing. When smoking status was added to the model, diagnostic performance improved further, which reached an AUC of 0.85. The team also developed a nomogram, a visual tool that estimates the probability of COPD based on DCR measurements and smoking history, and validated it using the Hosmer-Lemeshow test, confirming its reliability.
Overall, the study highlights DCR as a promising, less invasive alternative to PFTs for COPD screening. With strong correlations to traditional lung function metrics and high predictive accuracy, DCR could expand access to early COPD detection, particularly in settings where conventional testing is impractical.
Source:
Yu, D., Xie, W., Guo, Y., Zhu, X., Liang, W., Li, M., Mao, Y., He, Z., Wu, J., Yuan, L., Huang, W., Huang, J., He, S., Zhou, Z., Huang, X., Zhan, Y., Dong, H., Cai, S., Cui, Z.-K., … Liu, L. (2025). Dynamic chest radiography as an alternative to pulmonary function tests for chronic obstructive pulmonary disease. Radiology, 317(3), e251296. https://doi.org/10.1148/radiol.251296
