Evaluation of Chest Wall Diameter in Chest Radiography: Cross Sectional Study

doi:10.21203/rs.3.rs-3899216/v1

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Evaluation of Chest Wall Diameter in Chest Radiography: Cross Sectional Study

https://doi.org/10.21203/rs.3.rs-3899216/v1

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Background and aims:

A chest wall is an important diagnosis in the chest radiograph. It may give the first hint of respiratory or cardiovascular disease. The structure of the antero-posterior and transverse thoracic wall diameter varies greatly with factor such as age. Several diseases affect the chest wall diameter which includes, pectus excavatum, or carinatum, tilted sternum, prominent asymmetric costal cartilage, COPD conditions such as emphysema, etc., and several other respiratory diseases. In our study we measured the transverse chest wall diameter in the patient with and without a ventilator in portable chest radiography and also, we have compared the transverse chest wall diameter of routine chest PA view with AP view in chest radiography.

Methodology:

This study was a cross-sectional study. We selected 100 adult patients randomly and divided them into two groups of 50 in each group. In the group of first 50 patients we measured transverse chest wall diameter in same ventilator and non-ventilator patients, and another 50 patients who underwent routine AP and PA chest views. The data were computed using SPSS version 20.0 software.

Results

We noted that there was no significant difference in the transverse diameter of the chest wall in the same ventilator(25.68cm ± 2.015) and non-ventilator patients(25.80cm ± 2.195) with 50 numbers of same subjects using paired t-test (p-value ˃0.05). We also found that there was no significant difference in the transverse diameter of the chest wall in the same patient who had taken both AP view (25.56cm ± 2.779) and PA view (26.22cm ± 2.297) of the chest x-ray using paired t-test with remaining 50 numbers of same subjects (p-value ˃0.05).

Conclusion

We noted that there was no significant difference in the transverse chest wall diameter in same ventilator and non-ventilator patients of the chest radiograph and also in the comparison between AP and PA chest radiographs. Therefore, we can conclude that for measuring chest wall diameters one need not undergo both AP and PA radiographic views of the chest. Hence diagnosis can be done using routine PA chest radiograph.

Health sciences/Anatomy

Health sciences/Cardiology

Health sciences/Health care

Health sciences/Health occupations

Health sciences/Medical research

Antero-Posterior

Chronic Obstructive Pulmonary Disease

Postero-Anterior

Chest radiography is most common diagnostic test performed in the Radiology department, emergency ward, intensive care unit (ICU), and pre and post-surgical procedures⁽¹⁾. Chest radiographs are mostly used for the diagnosis of respiratory and cardio-thoracic diseases such as Pneumonia and cardiomegaly. The Antero-Posterior (AP) view and Postero-Anterior (PA) view of chest radiographs are most routinely performed in the radiology department. An AP view of the chest radiograph is taken either in upright or supine position but has less diagnostic detail than a PA projection chest radiograph and is usually taken for the bed-ridden patients to assess line and tube positioning, pneumothorax, lung collapsing and other conditions^{(2, 3)}.

The PA view of chest radiograph is widely used to help in the diagnosis of a variety of acute and chronic diseases affecting all thoracic cavity organs⁽⁴⁾. The CTR (Cardio-Thoracic Ratio) is slightly magnified in the AP view of the chest x-ray than PA view due to the object-image distance (OID)⁽⁵⁾.

The ventilator has been commonly used in the treatment of patients with respiratory diseases. In ventilator patients, the chest wall diameter is expanded in a full inspiration whereas it partially expands on expiration⁽⁶⁾.

The chest wall diameter varies greatly in patient with funnel chest, pigeon breast, and Harrison’s grooves⁽⁷⁾. In a recent investigation, the researchers discovered that one-third of patients had some difference in the anterior thoracic wall diameter⁽⁸⁾. This difference involved asymmetric observation, such as inclining sternum, prominent asymmetrical rib cartilage, perichondral nodes, a moderate degree of pectus excavate, or carinate^(9,10).

In our study, we evaluated the transverse diameter of the chest wall in the patient with and without a ventilator in portable chest radiography and also we compared the transverse diameter of the chest wall in routine chest PA view with chest AP view in radiography.

METHODOLOGY

This cross-sectional study was conducted in accordance with the relevant guidelines and regulations at a Justice K.S. Hegde Charitable Hospital, a unit of NITTE University (Deemed to be University), April 2020 - March 2021, after the approval by the Institutional Ethical Committee, K.S. Hegde Medical Academy (Approval no.INST.EC/EC/047/2020-21). A detailed explanation about the study was given by the principal investigator after which they provided consent for publication. All the patients included in this study gave written informed consent to publish the data contained within this study.

Inclusion Criteria

Patients between the age of 18–80 years, patients on ventilator and patients who underwent both routine Chest PA and AP view were included.

Exclusion Criteria

Patient with chest trauma were excluded.

Hypothesis

There is a significant difference in the transverse chest wall diameter in the radiographs of pre and post ventilator patients. Also, there is a difference in the transverse chest wall diameter when comparing AP and PA chest radiographs.

Study Procedure:

A total of 100 patients were randomly selected with an age range from 18–80 years. The first 50 patient's AP chest x-ray images were collected after the patients were subjected to a ventilator and AP chest radiographs were obtained post ventilation. The remaining 50 patients underwent routine radiography of PA and AP view of the chest performed by including the anatomy from the 7th cervical vertebrae to the 1st lumbar vertebrae. The transverse chest wall diameter was measured at the mid-level of the 10th dorsal vertebrae in the same ventilator and non-ventilator patient and also measured on both the chest AP and PA views of the same patient.

Statistical Analysis: All the collected data was recorded and analyzed by Statistical Package for Social Science Version 20.0 (SPSS-IBM CORPORATION, New York, 2014). Descriptive statistics are given in terms of Mean ± SD (Standard Deviation) / Frequency (%) for the variables. Paired t-test was applied for the variables: Transverse chest wall diameter in same ventilator and non-ventilator patient and Chest wall diameter in the same AP and PA view for pre and post comparison between them. Test statistic value along with 95% confidence interval and the p-value was reported. P-value calculated using a paired t-test.

P-value < 0.05 is considered as statistically significant.

In this study, 100 adult patients were randomly selected with an age range from 18–80 years by a simple random sampling technique which included 50 same ventilator and non-ventilator patients, only for AP view of chest radiography because these patients are hemodynamically unstable. Similarly, the remaining 50 patients underwent both AP and PA view of the chest radiography.

The mean transverse diameter of the chest wall was 25.68 ± 2.015 cm in ventilator patients and 25.80 ± 2.195 cm in non-ventilator patient with 50 number of same subjects. We noted that there was no significant difference in the transverse diameter of the chest wall in the same ventilator and non-ventilator patients (p-value ˃0.05). (Table 1 and Fig. 1)

The mean transverse diameter of the chest wall was 26.56 ± 2.779 cm in the AP view of the chest radiography and 26.22 ± 2.297 cm in the PA view of the chest radiography, with remaining 50 number of same subjects. We found that there was no significant difference in the transverse diameter of the chest wall in the same patient who had taken both AP and PA view of the chest x-ray (p-value ˃0.05). (Table 2 and Fig. 2)

A comparative study performed by Abhijit ray et al. including a total of 650 patients. They measured transverse chest wall diameter in gender categories (male- 350, female- 300). It was found that amongst the male's transverse chest diameter was 15.73 ± 11.65 cm whereas in females 15.473 ± 12.60 cm. the study concluded that transverse chest wall diameter was slightly more in males than in the females. And it increases as age increases⁽¹¹⁾.

In another research study investigated by, M. Ovia et al. including 30 male patients. They measured AP and transverse chest wall diameter using cardboard and a ruler. It was found that the AP and transverse chest wall diameter ratio of 5:7 in 22 patients and the remaining 8 have chest wall differences (at a 1:1 ratio) indicating the possibility of an essential respiratory or heart disorders⁽⁷⁾.

Though, most of the researchers showed that the PA view of the chest radiograph proved to be a standard tool for the measurement of the chest wall diameter. In our study, we measured the transverse chest wall diameter on the PA and AP view of the chest x-ray. We correlated the diameter measured in the same patient who had taken both AP view and PA view of the chest radiograph and found to have no significant difference between the two (p-value ˃0.05).

In a comparative study performed by Ibrahim MZ et al. with 200 patients to differentiate the soft tissue of the lateral thoracic wall with chest radiography on average adult and pulmonary TB patients and determine sex differences in the thickness of the lateral thoracic wall. The result indicated no substantial increase in lateral thickness of soft tissue between various sexes, but in pulmonary TB patients, the lateral thickness was lower than in healthy people. Thus, the author concluded that COPD patients displayed an increased thoracic cage AP diameter than normal controls⁽¹²⁾.

In another research study by Kaye H. Kilburn et al. included 47 subjects to measure the AP diameter and further chest measurements in patients diagnosed with pulmonary emphysema. They compared various chest diameters in 25 subjects with emphysema having shortness of breath, lung hyperinflation determined by the x-ray. 22 patients showed lower vital capacity, and lower expiratory airflow rate and sixteen standard conditions. They found that the expiratory AP diameter was more than the inspiratory and there was a significant difference of 2.1 cm between regular and medical patients with pulmonary emphysema. Therefore, the author concluded that the decreased body weight reducing the abdominal diameters was affecting the chest AP diameters showing it to be increased⁽¹³⁾.

The earlier studies have measured the transverse chest wall diameters but to the best of our knowledge, none of the studies compared the transverse chest wall diameter in same ventilator and non-ventilator patients as well as on same AP and PA chest radiography which has been measured in our studies.

Further studies can be performed by measuring the chest wall diameter by categorizing the various respiratory or cardiac diseases such as in asbestos worker, smokers, alcoholics, etc. Also, we can correlate the chest wall diameter with various exposure technical factors such as penetration, respiration, patient movement, patient rotation, etc. The chest wall diameter can be measured in different modalities such as CT, Ultrasound (USG), and MRI (Magnetic resonance imaging).

The limitation of our study, the sample size is small compared to the other studies.

Data Availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Ethics Declaration

The authors declare that there is no conflict of interest.

ACKNOWLEGMENT

We are thankful to the department of Radiodiagnosis and medical imaging technology at K. S. Hegde Medical Academy, Mangaluru, Karnataka, for their approval and permission in collecting the data and carrying out this study smoothly. We also acknowledge the department of statistics, for their guidance during data analysis and interpretation.

Author Contribution

Mr. Shahjahur Maqbool Jamadar conceived the concept of the study, collected the data and contributed to the design of the research and analysis. Mr. Shashi Kumar Shetty were responsible for scientific supervision. All authors read and approved the final version of manuscript.

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Table 1

Paired samples statistics of transverse chest wall diameter in ventilator patient and non-ventilator patient
	N	Mean(cm) ± SD	p-value
Chest Wall Diameter-Ventilator Patient	50	25.68 ± 2.015	1.000
Chest Wall Diameter- Non-Ventilator Patient	50	25.80 ± 2.195	1.000

Table 2

Paired samples statistics of transverse chest wall diameter in AP view and PA view of chest radiography
	N	Mean(cm) ± SD	p-value
Chest Wall Diameter in AP View	50	26.56 ± 2.779	.074
Chest Wall Diameter in PA View	50	26.22 ± 2.297	.074

No competing interests reported.

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Version 1

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Evaluation of Chest Wall Diameter in Chest Radiography: Cross Sectional Study

Status:

Version 1

Abstract

Background and aims:

Methodology:

Results

Conclusion

Figures

INTRODUCTION

MATERIALS AND METHODOLOGY

Study Procedure:

RESULTS

DISCUSSION

LIMITATIONS

CONCLUSION

Declarations

Data Availability

Ethics Declaration

ACKNOWLEGMENT

Author Contribution

References

Tables

Additional Declarations

Status:

Version 1