%0 Journal Article %A Thomas Simon FitzMaurice %A Caroline McCann %A Dilip S. Nazareth %A Martin J. Walshaw %T Characterisation of hemidiaphragm dysfunction using dynamic chest radiography: a pilot study %D 2021 %R 10.1183/23120541.00343-2021 %J ERJ Open Research %P 00343-2021 %X Objectives Dynamic chest radiography (DCR) is a novel real-time digital fluoroscopic imaging system that produces clear, wide field-of-view diagnostic images of the thorax and diaphragm in motion, alongside novel metrics on moving structures within the thoracic cavity. We describe the use of DCR in the measurement of diaphragm motion in a pilot series of cases of suspected diaphragm dysfunction.Methods We studied 21 patients referred for assessment of diaphragm function due to suspicious clinical symptoms or imaging (breathlessness, orthopnoea, reduced exercise tolerance, and/or an elevated hemidiaphragm on plain chest radiograph). All underwent DCR with voluntary sniff manoeuvres.Results Paradoxical motion on sniffing was observed in 14 patients, and confirmed in 6 who also underwent fluoroscopy or ultrasound. In 4 patients, DCR showed reduced hemidiaphragm excursion but no paradoxical motion; in 3, normal bilateral diaphragm motion was demonstrated. DCR was quick to perform, well-tolerated in all cases and with no adverse events reported. DCR was achieved in around five minutes per patient, with images available to view by the clinician immediately within the clinical setting.Conclusion DCR is a rapid, well-tolerated and straightforward X-ray technique that warrants further investigation in the assessment of diaphragm dysfunction.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Caroline McCann has nothing to disclose.Conflict of interest: Dilip S. Nazareth has nothing to disclose.Conflict of interest: Martin J. Walshaw has nothing to disclose. %U https://openres.ersjournals.com/content/erjor/early/2022/01/04/23120541.00343-2021.full.pdf