European Radiology

, Volume 29, Issue 4, pp 1665–1673 | Cite as

Initial clinical evaluation of stationary digital chest tomosynthesis in adult patients with cystic fibrosis

  • Elias Taylor GunnellEmail author
  • Dora K. Franceschi
  • Christina R. Inscoe
  • Allison Hartman
  • Jennifer L. Goralski
  • Agathe Ceppe
  • Brian Handly
  • Cassandra Sams
  • Lynn Ansley Fordham
  • Jianping Lu
  • Otto Zhou
  • Yueh Z. Lee



The imaging evaluation of cystic fibrosis currently relies on chest radiography or computed tomography. Recently, digital chest tomosynthesis has been proposed as an alternative. We have developed a stationary digital chest tomosynthesis (s-DCT) system based on a carbon nanotube (CNT) linear x-ray source array. This system enables tomographic imaging without movement of the x-ray tube and allows for physiological gating. The goal of this study was to evaluate the feasibility of clinical CF imaging with the s-DCT system.

Materials and methods

CF patients undergoing clinically indicated chest radiography were recruited for the study and imaged on the s-DCT system. Three board-certified radiologists reviewed both the CXR and s-DCT images for image quality relevant to CF. CF disease severity was assessed by Brasfield score on CXR and chest tomosynthesis score on s-DCT. Disease severity measures were also evaluated against subject pulmonary function tests.


Fourteen patients underwent s-DCT imaging within 72 h of their chest radiograph imaging. Readers scored the visualization of proximal bronchi, small airways and vascular pattern higher on s-DCT than CXR. Correlation between the averaged Brasfield score and averaged tomosynthesis disease severity score for CF was -0.73, p = 0.0033. The CF disease severity score system for tomosynthesis had high correlation with FEV1 (r = -0.685) and FEF 25–75% (r = -0.719) as well as good correlation with FVC (r = -0.582).


We demonstrate the potential of CNT x-ray-based s-DCT for use in the evaluation of cystic fibrosis disease status in the first clinical study of s-DCT.

Key Points

Carbon nanotube-based linear array x-ray tomosynthesis systems have the potential to provide diagnostically relevant information for patients with cystic fibrosis without the need for a moving gantry.

Despite the short angular span in this prototype system, lung features such as the proximal bronchi, small airways and pulmonary vasculature have improved visualization on s-DCT compared with CXR. Further improvements are anticipated with longer linear x-ray array tubes.

Evaluation of disease severity in CF patients is possible with s-DCT, yielding improved visualization of important lung features and high correlation with pulmonary function tests at a relatively low dose.


Tomography Nanotubes, Carbon X-rays Cystic fibrosis Scoring methods 



Adapted fan-beam volume reconstruction


Cystic fibrosis


Carbon nanotube


Digital chest tomosynthesis

FEF 25–75%

Forced expiratory flow at 25–75% of the pulmonary volume


Forced expiratory volume during the first second


Forced vital capacity


Intra-class correlation coefficients


Lateral costophrenic angles


Pulmonary function tests


Stationary digital chest tomosynthesis



This project was supported by a Translational Team Science Award with funding provided by the UNC School of Medicine and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through grant award no. UL1TR001111. This work is partially supported by the NCI-funded Carolina Center for Cancer Nanotechnology Excellence (5U54CA151652), a grant from the NCI (5R21CA185741) and The University of North Carolina School of Medicine Team Translation Science Award (TTSA001P2). Dr. Goralski was supported by the Cystic Fibrosis Foundation, grant award nos. GORALS16C0 and GORALS12L0. This project was further supported by the Howard Holderness Distinguished Medical Scholar grant. Hardware support was also provided by Carestream Health Inc. (Rochester, NY).

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Yueh Lee MD, PhD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Drs. Lee, Zhou and Lu are co-inventors of the stationary chest tomosynthesis imaging system evaluated in this study. Dr. Zhou has equity ownership and serves on the board of directors of Xintek, Inc., to which the technologies used or evaluated in this article have been or will be licensed. Dr. Lu has equity ownership in Xintek, Inc. All of these relationships are under management by the University of North Carolina's COI committees.

Statistics and biometry

Mrs. Agathe Ceppe, MS, kindly provided statistical advice for this manuscript.

Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• experimental

• performed at one institution

Supplementary material

330_2018_5703_MOESM1_ESM.avi (119.5 mb)
ESM 1 (AVI 122356 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Elias Taylor Gunnell
    • 1
    Email author
  • Dora K. Franceschi
    • 1
  • Christina R. Inscoe
    • 2
  • Allison Hartman
    • 2
  • Jennifer L. Goralski
    • 3
    • 4
    • 5
  • Agathe Ceppe
    • 3
  • Brian Handly
    • 6
  • Cassandra Sams
    • 6
  • Lynn Ansley Fordham
    • 6
  • Jianping Lu
    • 2
  • Otto Zhou
    • 2
  • Yueh Z. Lee
    • 2
    • 3
    • 6
    • 7
    • 8
  1. 1.School of MedicineThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Physics and AstronomyThe University of North Carolina at Chapel HillChapel HillUSA
  3. 3.Marsico Lung InstituteThe University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Division of Pulmonary and Critical Care MedicineThe University of North Carolina at Chapel HillChapel HillUSA
  5. 5.Division of Pediatric PulmonologyThe University of North Carolina at Chapel HillChapel HillUSA
  6. 6.Department of RadiologyThe University of North Carolina at Chapel HillChapel HillUSA
  7. 7.Lineberger Comprehensive Cancer CenterThe University of North Carolina at Chapel HillChapel HillUSA
  8. 8.Biomedical Research Imaging CenterThe University of North Carolina at Chapel HillChapel HillUSA

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