TY - JOUR
T1 - Uncertainty analysis of chest X-ray lung height measurements and size matching for lung transplantation
AU - Guillamet, Rodrigo Vazquez
AU - Guillamet, Maria C.Vazquez
AU - Rjob, Ashraf
AU - Bierhals, Andrew
AU - Bello, Irene
AU - Abularach, Alberto Jauregui
AU - Tague, Laneshia
AU - Wallendorf, Michael
AU - Marklin, Gary F.
AU - Witt, Chad
AU - Byers, Derek E.
AU - Kreisel, Daniel
AU - Nava, Ruben
AU - Puri, Varun
AU - Hachem, Ramsey
AU - Trulock, Elbert P.
N1 - Funding Information:
Peer Review File: Available at https://jtd.amegroups.com/ article/view/10.21037/jtd-21-1755/prf Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups. com/article/view/10.21037/jtd-21-1755/coif). DK serves as an unpaid editorial board member of Journal of Thoracic Disease. RVG reports that this research was supported by the Washington University Institute of Clinical and Translational Sciences Grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. MW reports receiving salary support from Grant UL1TR002345 from the National Center for Advancing Translational Science NCATS of the National Institute of Health (NIH). GFM is the Medical Director at Mid America Transplant. DEB reports receiving research funding from Mid-America Transplant. RH reports receiving research funding from Bristol Myers Squibb and Mallinkrodt, gent funding from Mid America Transplant and personal fees from Transmedics, CareDx, Thevavance, and Vectura. The other authors have no conflicts of interest to declare.
Funding Information:
Funding: This research was supported by the Washington University Institute of Clinical and Translational Sciences Grant UL1TR002345 from the National Center for
Publisher Copyright:
© 2022 AME Publishing Company. All rights reserved.
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - Lung transplantation
KW - agreement
KW - chest X-ray (CXR)
KW - error propagation
KW - precision
KW - size matching
UR - http://www.scopus.com/inward/record.url?scp=85129373576&partnerID=8YFLogxK
U2 - 10.21037/jtd-21-1755
DO - 10.21037/jtd-21-1755
M3 - Article
C2 - 35572863
AN - SCOPUS:85129373576
SN - 2072-1439
VL - 14
SP - 1042
EP - 1051
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
IS - 4
ER -