Improved donor lung size matching by estimation of lung volumes based on chest X-ray measurements

Organ size matching is an important determinant of successful allocation and outcomes in lung transplantation. While computed tomography (CT) is the gold standard, it is rarely used in an organ-donor context, and chest X-ray (CXR) may offer a practical and accurate solution in estimating lung volumes for donor and recipient size matching. We compared CXR lung measurements to CT-measured lung volumes and traditional estimates of lung volume in the same subjects.

Our retrospective study analyzed clinically obtained CXR and CT lung images of 250 subjects without evidence of lung disease (mean age 9.9 ± 7.8 years; 129 M/121F). From CT, each lung was semi-automatically segmented and total lung volumes were quantified. From anterior-posterior CXR view, each lung was manually segmented and areas were measured. Lung lengths from the apices to the mid-basal regions of each lung were measured from CXR. Quantified CT lung volumes were compared to the corresponding CXR lung lengths, CXR lung areas, height, weight, and predicted total lung capacity (pTLC).

There are strong and significant correlations between CT volumes and CXR lung areas in the right lung (R²  = .89, p < .0001), left lung (R²  = .87, p < .0001), and combined lungs (R²  = .89, p < .0001). Similar correlations were seen between CT volumes and CXR measured lung lengths in the right lung (R²  = .79, p < .0001) and left lung (R²  = .81, p < .0001). This correlation between anatomical lung volume (CT) and CXR was stronger than lung-volume correlation to height (R²  = .66, p < .0001), weight (R²  = .43, p < .0001), or pTLC (R²  = .66, p < .0001).

CXR measures correlate much more strongly with true lung volumes than height, weight, or pTLC. The ability to obtain efficient and more accurate lung volume via CXR has the potential to change our current listing practices of using height as a surrogate for lung size, with a case example provided.