Non-invasive measures of regional lung function and their clinical application in thoracic surgery

Oswald, Nicola ORCID: 0000-0002-8347-3385 (2021). Non-invasive measures of regional lung function and their clinical application in thoracic surgery. University of Birmingham. Ph.D.

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Abstract

The decision to operate, or not operate, is a critical step in the care of patients with a thoracic condition that potentially requires surgery. Weighing the risks and benefits of a thoracic operation involves careful assessment of the patient’s lung function and how this may be altered by surgery. This thesis will describe the application of multiple different methods to assess regional lung function in the context of assessing patients who may benefit from thoracic surgery. The patients are those with resectable Non-Small Cell Lung Cancer (NSCLC), interstitial lung disease (ILD), severe emphysema, and pleural thickening.
Prediction of postoperative lung function for NSCLC was reported to be most accurate and precise using CT based on a systematic review and meta-analysis but using density and volume changes was found to be unfeasible in a cohort study. The Lobar Segmentation and Parenchymal Analysis modules of the open access Chest Imaging Platform were found not to give reproducible results for lobar lung volume and density. Heterogeneity of specific volume of gas on CT in 2D did not help to discriminate between Usual Interstitial Pneumonia and other types of ILD, but heterogeneity was higher in ILD compared to reported values in health.
Measurement of chest wall movement did not show a clinically useful difference between patients with mesothelioma compared to benign pleural thickening. Chest wall motion did not have an association with prognosis in patients with mesothelioma; data provided external validation for the Brims decision tree prognostication. Early dynamic hyperinflation may be associated with symptomatic benefit from lung volume reduction but further study of this is required to confirm this. Key limitations exist in the available technologies; the lack of normal reference ranges is particularly important.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):