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(Chest. 1998;114:513-520.)
© 1998 American College of Chest Physicians

The Validity of Radiographic Estimation of Total Lung Capacity in Patients With Respiratory Disease

George P. Pappas MD1; Carl A. Brodkin MD, MPH1; Lianne Sheppard PhD1; John Balmes MD, MPH2; Martha Horike BS1; and Scott Barnhart MD, MPH1

1 From the Departments of Medicine and Environmental Health, University of Washington, Seattle
2 From the Department of Medicine, University of California, San Francisco

Study objective: To evaluate the validity of a state-of-the-art computerized planimetry technique for estimation of total lung capacity (TLC) from chest radiographs, when applied to patients with clinical lung disease receiving routine chest radiographs.

Design: Retrospective clinical survey.

Setting: An occupational medicine diagnostic clinic.

Patients: A convenience sample of 40 subjects with asbestos-related lung disease, 5 patients with nonasbestos-related restrictive defects, 15 subjects with occupational asthma, and 10 subjects with irritant tracheobronchitis.

Results: Estimation of TLC using state-of-the-art computerized algorithms demonstrated limited agreement with conventional measures of TLC when applied to patients with occupational lung disease receiving routine chest radiographs. The most pronounced differences occurred in patients with asbestos-related lung disease and restrictive defects, where the radiographic method of measurement significantly overestimated helium dilution TLC by 986 mL (r=0.73, p<0.001) and 1,135 mL (r=0.82, p<0.05), respectively. Good inspiratory effort was associated with significantly increased radiographic TLC relative to helium dilution TLC; however, radiographic features did not fully account for the observed differences between radiographic and helium dilution techniques.

Conclusions: Our findings suggest that this planimetric technique should not be used as a substitute for conventional measures of TLC in clinic populations receiving routine radiographs. The large diagnostic group specific mean differences observed between radiographic and conventional measures of TLC also suggest that this method is of limited utility in clinical evaluation of occupational lung disease.

Key Words: chest radiographs • epidemiology • occupational medicine • planimetry • pulmonary function tests • validity

Submitted on December 28, 1995
Accepted on January 28, 1998






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Copyright © 1998 by the American College of Chest Physicians.