On visual determination of full inspiration on CT images

The aim of this study was to evaluate the ability of experienced thoracic radiologists to assess full inspiration based on two CT slices, one above and one below the carina, in normal subjects. Ten healthy volunteers were studied. Total lung capacity (TLC) was measured with a body plethysmograph. High-resolution computed tomography (HRCT) was performed in two slices at TLC and at various expired volumes. Mean Hounsfield values (HU) were calculated. Unidentifiable images, stored on a web server, were analysed visually by experienced thoracic radiologists. The results show that the mean lung density at TLC varied by approximately 40 HU between individuals. Within an individual this may correspond to a decrease in lung volume of approximately 25% of TLC. On visual determination of images taken at 65-74% of TLC, more than one-third of the images were assessed as taken at full inspiration; of the images taken at 75-84% of TLC, approximately 50% were assessed as taken at full inspiration. We conclude that visual determination of full inspiration on CT images in normal subjects is highly inaccurate. If quantitative density measurements are to be used in the diagnosis or follow-up of lung disease, thorough control of full inspiration is recommended.