Improved air trapping evaluation in chest computed tomography in children with cystic fibrosis using real-time spirometric monitoring and biofeedback

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Improved air trapping evaluation in chest computed tomography in children with cystic fibrosis using real-time spirometric monitoring and biofeedback Thomas Kongstad, Frederik F. Buchvald, Kent Green, Anders Lindblad, Terry E. Robinson, Kim G. Nielsen Journal of Cystic Fibrosis Volume 12, Issue 6, Pages 559-566 (December 2013) DOI: 10.1016/j.jcf.2013.05.012 Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 1 Computer biofeedback displaying dynamic volume-time curve during scanning. The red lines mark the 10% and 90% of Slow Vital Capacity volumes to be reached for expiratory and inspiratory sequences. Refer to online supplement for a short video of the bio-feedback animation. Volume-time data are stored for documentation and post-processing. Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 2 The child is placed in the scanner with the monitor and the pneumotachograph held in place by a support arm. Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 3 Examples of expiratory images with Point Of Interest-markings of unaffected lung tissue without airtrapping, consolidation or large vessels. The mean value of attenuation inside the circle is registered. Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 4 Lung attenuation during inspiratory and expiratory sequences for the Copenhagen A) and Gothenburg B) group. A successful breath hold manoeuvre provides a large change in attenuation between sequences. Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 5 Air trapping scores in the Copenhagen (CPH) and Gothenburg (GTB) centre. A maximum score of 12 is given if air trapping is seen in more than 50% of lung tissue in all 3 expiratory images. The GTB group scores are significantly lower than the CPH group (p<0.0001). Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Fig. 6 Scatter plot showing the correlation between air trapping score and delta attenuation. (R=0.57 p<0.0001) An ineffective breath hold manoeuvre with a small change in lung attenuation is more likely to result in a low air trapping score. Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Supplementary Fig. 1 Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Supplementary Fig. 2 Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Supplementary Fig. 3 Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions

Supplementary Fig. 4 A plot of HU densities on 1mm vs. 3mm slice thicknesses. Journal of Cystic Fibrosis 2013 12, 559-566DOI: (10.1016/j.jcf.2013.05.012) Copyright © 2013 European Cystic Fibrosis Society. Terms and Conditions