AUTHOR=Kirkness Jason P. , Dusting Jonathan , Eikelis Nina , Pirakalathanan Piraveen , DeMarco John , Shiao Stephen L. , Fouras Andreas TITLE=Association of x-ray velocimetry (XV) ventilation analysis compared to spirometry JOURNAL=Frontiers in Medical Technology VOLUME=5 YEAR=2023 URL=https://www.frontiersin.org/journals/medical-technology/articles/10.3389/fmedt.2023.1148310 DOI=10.3389/fmedt.2023.1148310 ISSN=2673-3129 ABSTRACT=Introduction

X-ray Velocimetry (XV) ventilation analysis is a 4-dimensional imaging-based method for quantifying regional ventilation, aiding in the assessment of lung function. We examined the performance characteristics of XV ventilation analysis by examining correlation to spirometry and measurement repeatability.

Methods

XV analysis was assessed in 27 patients receiving thoracic radiotherapy for non-lung cancer malignancies. Measurements were obtained pre-treatment and at 4 and 12-months post-treatment. XV metrics such as ventilation defect percent (VDP) and regional ventilation heterogeneity (VH) were compared to spirometry at each time point, using correlation analysis. Repeatability was assessed between multiple runs of the analysis algorithm, as well as between multiple breaths in the same patient. Change in VH and VDP in a case series over 12 months was used to determine effect size and estimate sample sizes for future studies.

Results

VDP and VH were found to significantly correlate with FEV1 and FEV1/FVC (range: āˆ’0.36 to āˆ’0.57; pā€‰<ā€‰0.05). Repeatability tests demonstrated that VDP and VH had less than 2% variability within runs and less than 8% change in metrics between breaths. Three cases were used to illustrate the advantage of XV over spirometry, where XV indicated a change in lung function that was either undetectable or delayed in detection by spirometry. Case A demonstrated an improvement in XV metrics over time despite stable spirometric values. Case B demonstrated a decline in XV metrics as early as 4-months, although spirometric values did not change until 12-months. Case C demonstrated a decline in XV metrics at 12 months post-treatment while spirometric values remained normal throughout the study. Based on the effect sizes in each case, sample sizes ranging from 10 to 38 patients would provide 90% power for future studies aiming to detect similar changes.

Conclusions

The performance and safety of XV analysis make it ideal for both clinical and research applications across most lung indications. Our results support continued research and provide a basis for powering future studies using XV as an endpoint to examine lung health and determine therapeutic efficacy.