title: Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD.
abstract: BACKGROUND
  The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), using a fluoroscopy-guided chest X-ray.
  
  
  METHODS
  Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.
  
  
  RESULTS
  There were significant improvements (2,022.8±1,548.3 mm(2) to 3,010.7±1,495.6 mm(2) and 2,382.4±1,475.9 mm(2) to 3,315.9±1,883.5 mm(2); right side P=0.001 and left side P=0.019, respectively) in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.
  
  
  CONCLUSIONS
  The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary rehabilitation in COPD patients in terms of cost and time savings compared with computed tomography or magnetic resonance imaging.
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Republic of Korea.
authors: Eun Mi
authors: EM
authors: Chun
authors: Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors: Soo Jeong
authors: SJ
authors: Han
authors: Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Republic of Korea.
authors: Hitesh N
authors: HN
authors: Modi
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000503:physiopathology; D045853:Exhalation; D005471:Fluoroscopy; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D055070:Resistance Training; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome
keywords: COPD; diaphragmatic movement; fluoroscopy; pulmonary rehabilitation