Uncertainty analysis of chest X-ray lung height measurements and size matching for lung transplantation

Journal of Thoracic Disease

article

Rodrigo Vazquez Guillamet¹  Maria C. Vazquez Guillamet¹  Ashraf Rjob²  Andrew Bierhals³  Irene Bello⁴  Alberto Jauregui Abularach⁴  Laneshia Tague¹  Michael Wallendorf⁵  Gary F. Marklin⁶  Chad Witt¹  Derek E. Byers¹  Daniel Kreisel⁷  Ruben Nava⁷  Varun Puri⁷  Ramsey Hachem¹  Elbert P. Trulock¹ 

[1] Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital;Division of Infectious Diseases at Washington University - Barnes Jewish Hospital;Radiology Department at Washington University - Barnes Jewish Hospital;Division of Thoracic Surgery and Lung Transplantation at Vall d’Hebron University Hospital;Division of Statistics at Washington University School of Medicine;Mid-America Transplant;Division of Thoracic Surgery at Washington University - Barnes Jewish Hospital

关键词: Lung transplantation;    size matching;    chest X-ray (CXR);    error propagation;    agreement;    precision;   

DOI  :  10.21037/jtd-21-1755

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Errors in measuring chest X-ray (CXR) lung heights could contribute to the occurrence of size-mismatched lung transplant procedures. Methods: We first used Bland-Altman analysis for repeated measures to evaluate contributors to measurement error of chest X-ray lung height. We then applied error propagation theory to assess the impact of measurement error on size matching for lung transplantation. Results: A total 387 chest X-rays from twenty-five donors and twenty-five recipients were measured by two raters. Individual standard deviation for lung height differences were independent of age, sex, donor vs. recipient, diagnostic group and race/ethnicity and all were pooled for analysis. Bias between raters was 0.27 cm (±0.03) and 0.22 cm (±0.06) for the right and left lung respectively. Within subject variability was the biggest contributor to error in measurement, 2.76 cm (±0.06) and 2.78 cm (±0.2) for the right and left lung height. A height difference of 4.4 cm or more (95% CI: ±4.2, ±4.6 cm) between the donor and the recipient right lung height has to be accepted to ensure matching for at least 95% of patients with the same true lung height. This difference decreases to ±1.1 cm (95% CI: ±0.9, ±1.3 cm) when the average from all available chest X-rays is used. The probability of matching a donor and a recipient decreases with increasing true lung height difference. Conclusions: Individual chest X-ray lung heights are imprecise for the purpose of size matching in lung transplantation. Averaging chest X-rays lung heights reduced uncertainty.

【 授权许可】

Unknown