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 - 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 -