Abstract
Disorders of the lungs such as chronic obstructive pulmonary disease (COPD) are a major cause of chronic morbidity and mortality and the third leading cause of death in the world. The absence of sensitive diagnostic tests for early disease stages of COPD results in under-diagnosis of this treatable disease in an estimated 60–85% of the patients. In recent years a grating-based approach to X-ray dark-field contrast imaging has shown to be very sensitive for the detection and quantification of pulmonary emphysema in small animal models. However, translation of this technique to imaging systems suitable for humans remains challenging and has not yet been reported. In this manuscript, we present the first X-ray dark-field images of in-situ human lungs in a deceased body, demonstrating the feasibility of X-ray dark-field chest radiography on a human scale. Results were correlated with findings of computed tomography imaging and autopsy. The performance of the experimental radiography setup allows acquisition of multi-contrast chest X-ray images within clinical boundary conditions, including radiation dose. Upcoming clinical studies will have to demonstrate that this technology has the potential to improve early diagnosis of COPD and pulmonary diseases in general.
Highlights
Lung diseases, such as chronic obstructive pulmonary disease (COPD), lower respiratory infections and lung cancer are some of the most common medical conditions in the world
We demonstrate for the first time the successful translation of X-ray dark-field radiography from small-animal imaging systems to a setup capable of imaging human thoraces, including imaging parameters such as scan duration, field-of-view, and radiation dose being appropriate for patients
With respect to lung diagnostics, studies have estimated that 60–85% of the general population suffering from COPD, mainly those with mild to moderate symptoms, have not been diagnosed [31]
Summary
Lung diseases, such as chronic obstructive pulmonary disease (COPD), lower respiratory infections and lung cancer are some of the most common medical conditions in the world. According to the most recent (2015) world health organization (WHO) data [1], COPD ranks level with lower respiratory infections as the third leading cause of death globally, claiming over 3 million lives each year (5.7% of all deaths). Since its clinical introduction in the early 1900s, the principle of image contrast formation in conventional X-ray imaging has solely been based on X-ray attenuation. X-rays have wave properties and are subject to effects like refraction and ultra small-angle scattering (which leads to dark-field contrast). Those effects cannot be visualized with a conventional X-ray imaging system. The method has already been implemented in several experimental setups [8,9], a prototypical pre-clinical mammography demonstrator system [10], a radiographic projection system for osteoarthritis diagnosis in finger joints [11], and a first in-vivo dark-field small-animal CT system[12]
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