Quantitative analysis of changes in lung density by dynamic chest radiography in association with CT values: a virtual imaging study and initial clinical corroboration

Dynamic chest radiography (DCR) identifies pulmonary impairments as decreased changes in radiographic lung density during respiration (Δpixel values), but not as scaled/standardized computed tomography (CT) values. Quantitative analysis correlated with CT values is beneficial for a better understanding of Δpixel values in DCR-based assessment of pulmonary function. The present study aimed to correlate Δpixel values from DCR with changes in CT values during respiration (ΔCT values) through a computer-based phantom study. A total of 20 four-dimensional computational phantoms during forced breathing were created to simulate both CT and projection images of the same virtual patients. The Δpixel and ΔCT values of the lung fields were correlated on a regression line, and the inclination was statistically evaluated to determine whether there were significant differences among physical types, sex, and breathing methods. The resulting conversion expression was also assessed in the DCR images of 37 patients. The resulting Δpixel values for 30/37 (81%) real patients, 6/7 (86%) normal controls, and 24/30 (80%) chronic obstructive pulmonary disorder patients were within the range of ΔCT values ± standard deviation (SD) reported in a previous study. In addition, no significant differences were detected for each condition of thoracic breathing, suggesting that the same regression line inclination values measured across the entire lung can be used for the conversion of Δpixel values, providing a quantitative analysis that can be correlated with ΔCT values. The developed conversion expression may be helpful for improving the understanding of respiratory changes using radiographic lung densities from DCR-based assessments of pulmonary function.