title: Tomographic comparison of ventilation techniques for CT-guided thoracoscopic staple excision of subcentimeter lung nodules.
abstract: This study was planned to compare the computed tomographic detectability of lung nodules in three ventilatory conditions: total lung capacity, high-frequency ventilation, and total lung deflation. In an ex vivo lung model, 44 nodules were simulated. Using computed tomography (CT) scans, nodules were detected and compared to the actual number and excised under CT guidance. Simulated nodules measured 6.2 +/- 2.1 mm and demonstrated an attenuation of 175 +/- 14 HU. Observer confidence was highest at total lung capacity (5.00 +/- 0.00), in comparison to high-frequency ventilation and total lung deflation (4.69 +/- 0.78, 4.94 +/- 0.27, p = .24). The kappa score for total lung capacity, high-frequency ventilation, and total lung deflation was 1.00, 0.96, and 0.98, respectively, indicating a very high interrater reliability. Although surgical devices generated a substantial artifact, 90% of nodules were excised. Thus, although total lung capacity produces the highest confidence level, all three of the ventilatory techniques examined have similar detection of subcentimeter pulmonary nodules using computed tomography scans.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Humberto
authors.initials: H
authors.lastname: Lara-Guerra
authors.forename: Steve E
authors.initials: SE
authors.lastname: Kalloger
authors.forename: Tom
authors.initials: T
authors.lastname: Powell
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Kim
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Clifton
authors.forename: John Richard
authors.initials: JR
authors.lastname: Finley
authors.forename: John Robert
authors.initials: JR
authors.lastname: Mayo
mesh_terms: D000818:Animals; D016477:Artifacts; D005260:Female; D006611:High-Frequency Jet Ventilation; D066298:In Vitro Techniques; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D015588:Observer Variation; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000473:pathology*; D012121:Respiration, Artificial; D013552:Swine; D013906:Thoracoscopy / Q000379:methods* / Q000706:statistics & numerical data; D013990:Tidal Volume; D014057:Tomography, X-Ray Computed; D014109:Total Lung Capacity