Computed Tomography Scanning Techniques for the
Evaluation of Cystic Fibrosis Lung Disease
Terry E. Robinson1
1
Center of Excellence in Pulmonary Biology, Division of Pediatric Pulmonary, Stanford University Medical Center, Palo Alto, California
Multidetector computed tomography (MDCT) scanners allow diag-
nosis and monitoring of cystic fibrosis (CF) lung disease at substan-
tially lower radiation doses than with prior scanners. Complete
spiral chest CT scans are accomplished in less than 10 seconds
and scanner advances now allow the acquisition of comprehensive
volumetric datasets for three-dimensional reconstruction of the
lungs and airways. There are two types of CT scanning protocols
currently used to assess CF lung disease: (1 ) high-resolution CT
(HRCT) imaging, in which thin 0.5–1.5-mm slices are obtained every
0.5, 1, or 2 cm from apex to base for inspiratory scans, and limited,
spaced HRCT slices obtained for expiratory scans; and (2 ) complete
spiral CT imaging covering the entire lung for inspiratory and expir-
atory scanning. These scanning protocols allow scoring of CF lung
disease and provide CT datasets to quantify airway and air-trapping
measurements. CF CT scoring systems typically assess bronchiecta-
sis, bronchial wall thickening, mucus plugging, and atelectasis/con-
solidation from inspiratory scans, whereas air trapping is scored
from expiratory imaging. Recently, CT algorithms have been devel-
oped for both HRCT and complete spiral CT imaging to quantify several
airway indices, to determine the volume and density of the lung,
and to assess regional and global air trapping. CT scans are currently
acquired by either controlled-volume scanning techniques (controlled-
ventilation infant CT scanning or spirometer-controlled CT scanning
in children and adults) or by voluntary breath holds at full inflation
and deflation.
Keywords: HRCT; CF; spiral CT; volume control
COMPUTED TOMOGRAPHY SCANNER TECHNIQUES
Multidetector computed tomography (MDCT) scanners allow
greater flexibility in the design of CT protocols to evaluate CF
lung disease than prior scanners. Complete spiral chest CT scan-
ning of the lungs from apex to base can now be accomplished
in less than 10 seconds for 32 or more detector scanners, and
less than 13 seconds for 16 detector scanners. Current scanner
designs allow adjustment of CT dose parameters to limit radia-
tion exposure and allow the CT technologist to use either thin-
slice high-resolution CT (HRCT) imaging or spiral CT imaging
of the entire chest. Comprehensive volumetric datasets from
spiral CT imaging can further provide three-dimensional (3D)
reconstruction of the lungs and airways.
HRCT
High-resolution CT techniques sample the lung by acquiring
thin, 0.5- to 1.5-mm slices every 0.5, 1, or 2 cm with gaps between
slices (45). Scans are usually obtained from the apex to the base
(Received in original form December 2, 2006; accepted in final form April 9, 2007 )
Correspondence and requests for reprints should be addressed to Terry E. Robinson,
M.D., Center of Excellence for Pulmonary Biology, Division of Pediatric Pulmonary,
Stanford University School of Medicine, 770 Welch Road, Suite 350, Palo Alto,
CA 94305-5715. E-mail: ter@stanford.edu
Proc Am Thorac Soc Vol 4. pp 310–315, 2007
DOI: 10.1513/pats.200612-184HT
Internet address: www.atsjournals.org
of the lungs during inspiration. For expiratory scans, a smaller
number of HRCT images are obtained, which are either evenly
spaced from apex to the base or are obtained at anatomically
determined locations. Using inspiratory and expiratory HRCT
images, cystic fibrosis (CF) CT scoring systems have typically
assessed bronchiectasis, bronchial wall thickening, mucus plug-
ging, and atelectasis/consolidation from inspiratory scans, whereas
air trapping is scored from expiratory imaging. Inspiratory HRCT
scans acquired at intervals greater than 10 mm (typically 14 slices
or less) result in significantly lower CF CT severity scores and limit
the ability to detect worsening scores at 2 years (1). For expiratory
imaging, regional air trapping has been assessed with three or
more HRCT images that can sample the upper, middle, and
lower lung regions (2–5). Because the CT scanner must move
and stop the patient for each slice, HRCT requires more time
than spiral CT. HRCT scans typically require 2 seconds for
each slice, or greater than 40 seconds for lung sizes greater than
20 cm in length, necessitating two or more scanning maneuvers.
The major advantage of HRCT imaging is that high-resolution
images can be obtained with lower radiation exposure compared
with complete spiral CT protocols. The major disadvantages
with this technique include the longer scan times necessary to
sample the entire lung, the limited view of scanned lungs in only
the axial plane with HRCT imaging, and the difficulties that
exist in obtaining anatomically matched airways or regional pa-
renchyma for serial HRCT scans obtained before and after spe-
cific treatments in clinical trials.
HRCT imaging is an optimal technique for evaluating lung
disease in infants, children, and adults with CF in a clinical setting,
Using low-dose strategies (100 kVp and 20–40 mAs) and obtaining
slices every 0.5 to 1 cm from apex to base during inspiratory and
expiratory scans, optimal information can be obtained with low
radiation exposure (0.2–0.3 mSv) corresponding to approximately
two to three chest radiographs (ImPACT CT Patient Dosimetry
Calculator, version 0.99x; National Health Service, London, UK)
(6) given the dose of chest radiographs is 0.1 mSv (7).
Spiral CT
Current multidetector scanners can provide complete volumetric
datasets obtained from spiral CT protocols. Spiral CT provides
contiguous thin sections through the entire chest. The scanning
technique is relatively similar for all multidetector CT scanners
that have 16 or more detectors. The advantage of higher detector
scanners is chiefly in the thinner slice capabilities and more rapid
scan acquisitions allowing for greater resolution in the Z (head
to toe) direction for 3D reconstructions and shorter total scan
time. Typical slice thicknesses range from 0.5 to 1.25 mm (45).
The entire lung can be scanned in as little as 5 to 10 seconds (45).
The major advantages of spiral CT imaging include the ability
to better match airways and regional air trapping in CT scans
obtained before and after specific interventions in clinical trials
as well as the ability to provide comprehensive 3D assessment
of lung parenchyma and airway abnormalities noted in CF. Two
examples of this are presented in Figure 1, in which the lung
has been segmented into specified lobes and the airways have been
segmented into a tracheobronchial tree by 3D reconstruction (45).
Robinson: Chest CT Scanning Techniques in CF 311

Figure 1. Three-dimensional
tracheobronchial airway seg-
mentation with defined bron-
chial segments in two adoles-
cents with cystic fibrosis (CF),
and two- and three-dimen-
sional lobar segmentation in a
19-year-old adolescent with
CF. Computed tomography
(CT) scans obtained with a spi-
ral CT protocol using 80 kVp,
70 mAs, 0.6 mm collimation, 0.5-
second scan rotation, pitch ⫽ 1
on a Siemens Sensation 64 CT
scanner (Siemens, Malvera,
PA). (A ) Diffuse enlarged bron-
chial airways (bronchiectasis)
in the right upper lobe and
lower lobes designated by the
arrowheads in a 15-year-old ad-
olescent with more severe CF
lung disease compared with
(B ) a 19-year-old adolescent
with mild CF lung disease. (C )
Lobar segmentation in the 19-
year-old adolescent with mild
CF lung disease. LLL ⫽ left
lower lobe; LUL ⫽ left upper
lobe; RLL ⫽ right lower lobe;
RML ⫽ right middle lobe; RUL ⫽
right upper lobe. Upper images
in A and B, and all images in
C, were processed with Vida Diagnostics Software (Vida Diagnostics, Iowa City, IA); lower images in A and B were processed with software developed
by the Stanford University Medical Center Cystic Fibrosis Post-Processing Lab (Stanford, CA). Reprinted by permission from Reference 45.
312 PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY VOL 4 2007

In Figure 1, two patients with CF with and without significant
bronchiectasis are presented. The segmented airway in the Fig-
ure 1A reveals significant advanced bronchiectasis (arrowheads)
in contrast to minimal airway disease in the subject with in Figure
1B. Another advantage of spiral CT scans is that more airways
can be identified and accurately measured with quantitative CT
algorithms compared with HRCT imaging (8). Spiral CT scans
can further allow quantification of air trapping for all lung re-
gions and can provide a calculation of total lung volume by
CT assessment. The major disadvantages of spiral CT imaging
includes the higher radiation dose compared with HRCT proto-
cols and the slight decreased resolution of CT images compared
with HRCT scans.
Spiral CT is an optimal technique for research protocols that
can provide comprehensive serial assessment of the lung for CF
research. New approaches with lower dose scans are now possi-
ble with multidetector CT scanners. Using low-dose strategies
(100 kVp and 20–40 mAs) for inspiratory and expiratory spiral
scans, the total radiation exposure is approximately equivalent
to 0.5-year background radiation exposure at sea level (1.5 mSv)
(ImPACT CT Patient Dosimetry Calculator, version 0.99x) (6).
Promising capabilities of these low-dose scanning approaches
include the potential to provide quantitative airway measure-
ments out to the fifth and sixth generation airways for each lobe,
and regional air-trapping measurements by lung zone and, in the
near future, by lobe (45). With these techniques, it is anticipated
that regional abnormalities will be better detected, structural
changes in CF lung disease will be picked up earlier, and the
effects of specific therapeutic interventions will be more readily
ascertained during clinical research trials in children and adults
with CF.
LUNG VOLUME CONTROL
CT scan acquisition, especially expiratory CT imaging, is im-
pacted by the lung volume at which the scans are obtained (45).
Expiratory lung volumes near functional residual capacity lead
to significantly higher quantitative air-trapping values and lower
lung density values compared with CT scanning obtained at near
residual volume (4, 9). Obtaining expiratory CT scans at different
lung volumes on serial studies can lead to erroneous air-trapping
and lung attenuation values, limiting the ability of CT scanning

Figure 2. (A ) Volitional breath-hold computed tomography (CT) scanning technique. Note: each plateau of lung volume represents different high-
resolution CT scan acquisitions in a well-coached subject with CF instructed to take maximal inspiratory breath holds. Maximal differences in lung
volume for some scans amounted to 0.9 L. (B ) Spirometer-controlled CT scanning technique. Note: inspiratory CT scan obtained at set goal of
95% slow vital capacity (SVC). ERV ⫽ expiratory reserve volume.
Robinson: Chest CT Scanning Techniques in CF 313

to detect changes after an intervention. Quantitative airway mea-
surements are also affected by the degree of inspiratory lung
inflation (10).
Children younger than approximately 5 years cannot perform
the necessary maneuvers to provide inspiratory and expiratory
CT scans. For children from 5 to 8 years of age, cooperation will
frequently limit the quality of CT scans. Older subjects can perform
the necessary maneuvers, but without standardized volume control
techniques, lung volumes continue to vary at all ages.
CT scans can be acquired by either standardized controlled-
volume techniques (controlled-ventilation infant CT scanning
[11–17] and spirometer-controlled CT [2–5, 18, 19]) or by voli-
tional breath holds which are directed by the CT technologist
during inspiratory or expiratory CT imaging (20–42). An exam-
ple of a volitional breath-hold chest CT scan is presented in
Figure 2A and contrasted with a volume-controlled scan in
Figure 2B. Volitional breath-hold CT scans may result in incon-
sistent lung volume acquisition, especially with expiratory im-
aging. Volume-controlled scans provide reproducible CT im-
aging, especially for expiratory scanning. Controlled-ventilation
infant CT scan acquisition is described elsewhere in this sympo-
sium by Long (pp. 306–309).
Spirometer-controlled CT scanning uses a portable spirome-
ter unit that alerts the CT technologist when the subject’s lung
volume has reached a precise user-defined inspiratory or expir-
atory lung volume (Figure 3). Before CT scanning, supine spi-
rometry is performed to obtain supine lung volume measure-
ments (slow vital capacity [SVC], inspiratory capacity, and
expiratory reserve volume). Inspiratory and expiratory thresh-
olds as a given percentage of the SVC are then determined for
planned scan acquisition. For inspiratory scans, the threshold is
set at 95% or more of SVC. For expiratory scans, the threshold
is typically set to lung volumes corresponding to 5 to 12% of SVC,
which decreases the chances of obtaining erroneously higher air-
trapping values that have been reported for scans obtained near
functional residual capacity (4). With volitional breath-hold CT
scans, it is essential that the technologist practice both inspiratory
and expiratory breath-hold maneuvers, typically in the supine
position, before CT scan acquisition to minimize lung volume
variability as much as possible.

Figure 3. (A ) Spirometer-controlled chest computed tomography (CT) diagram indicating scan acquisitions at near full inflation, near functional
residual capacity (nFRC), and near residual volume (nRV). Note: Spirometer-controlled scans are routinely done at ⭓ 95% of slow vital capacity
(SVC) and nRV corresponding to 5–12% of the supine SVC. Corresponding matched axial CT slices: (B ) inspiratory scan at ⭓ 95% SVC), (C )
expiratory scan nFRC, and (D ) expiratory scan nRV. Note regions (*) (pulmonary lobules) with different degrees of air trapping best visualized
with expiratory CT scans obtained at nRV.
314
CT SCANNING TECHNIQUES IN PUBLISHED
RESEARCH TRIALS
Since 1997, several authors have used controlled-ventilation in-
fant CT scans to assess early lung disease in infants with CF
(11–17). Several authors have also used spirometer-controlled
CT imaging in children and adults with CF, ages 6 to 42 years,
with mild to severe lung disease (2–5, 18, 19). Controlled-volume
infant CT and spirometer-controlled CT protocols have been
used to demonstrate significant improvement in total HRCT
scores after intravenous antibiotics and airway clearance therapy
for a pulmonary exacerbation in infants and children with CF
(2, 17). Spirometer-controlled CT scanning has also been used
to demonstrate greater quantitative air trapping in children with
mild CF lung disease compared with normal control subjects,
and improvement in quantitative air trapping and a composite
HRCT/pulmonary function test score after 1 year of dornase
alfa therapy during a 1-year Pulmozyme (Genentech, South San
Francisco, CA) intervention study in children with mild CF lung
disease (2–5, 18, 19).
Volitional breath-hold CT imaging has been used in seven
CF intervention studies (22, 26, 28, 33–36, 39). Of these seven
studies, there has been only one study using an HRCT scoring
system that has demonstrated a significant difference after a
specific therapeutic intervention (28) other than antibiotic ther-
apy for a pulmonary exacerbation in children and adults with
CF (22, 34). Volitional CT scanning has also been used in an
ongoing natural history study of children and adults with CF
followed at Sophia Children’s Hospital in the Netherlands (31,
32, 38, 41, 42).
Both HRCT and volumetric CT images have been used by
the radiologist to score CF disease severity with different CF
CT scoring systems (1, 2, 5, 9, 12–14, 17, 19–43). In addition,
both types of scanning format have been used with quantitative
CT post-processing techniques, such as CT airway measurements
(8, 14, 15, 31) and quantitative air-trapping measurements (3–5,
15). Several CT scoring systems have been previously reviewed
(31). Recently developed CT algorithms can quantify several
airway indices on either HRCT or spiral CT scans, including
bronchial wall thickness, luminal diameter, wall area, and lumi-
nal area, as well as determine the volume and density of the lung
for inspiratory and expiratory CT images, and assess regional
and global air trapping (4, 8, 15). With these quantitative CT
algorithms, two authors have reported that large airways can
accurately be measured, but the accuracy of smaller airway mea-
surements become limited when airway lumen diameters are
smaller than 2.5 to 3.5 mm (43, 44). This approximates airway
sizes comparable to segmental and subsegmental airways for
older children and adults.
CONCLUSIONS
Because of advances in CT technology in the last 10 years, CT
scanning in CF children and adults has become much easier and
more efficient. CT scanning protocols are now available that
provide comprehensive assessment of CF lung disease with lower
radiation exposure. New scanning techniques provide greater
flexibility to design specific CT protocols to address early and
progressive disease using CF scoring systems and quantitative
CT outcome measures.
Conflict of Interest Statement : T.E.R. is currently the principal investigator on a
Novartis and Cystic Fibrosis Foundation Therapeutic Development Network Grant.
PROCEEDINGS OF THE AMERICAN THORACIC SOCIETY VOL 4 2007
References
1. de Jong PA, Nakano Y, Lequin MH, Tiddens HA. Dose reduction for
CT in children with cystic fibrosis: is it feasible to reduce the number
of images per scan. Pediatr Radiol 2006;36:50–53.
2. Robinson TE, Leung AN, Northway WH, Blankenberg FG, Bloch DA,
Oehlert JW, Al-Dabbagh H, Hubli S, Moss RB. Spirometer-triggered
high-resolution computed tomography and pulmonary function mea-
surements during an acute exacerbation in patients with cystic fibrosis.
J Pediatr 2001;138:553–559.
3. Goris ML, Zhu HJ, Blankenberg F, Chan F, Robinson TE. An automated
approach to quantitative air trapping measurements in mild cystic
fibrosis. Chest 2003;123:1655–1663.
4. Bonnel AS, Song SM, Kesavarju K, Newaskar M, Paxton CJ, Bloch DA,
Moss RB, Robinson TE. Quantitative air trapping analysis in children
with mild cystic fibrosis pulmonary disease. Pediatr Pulmonol
2004;38:396–405.
5. Robinson TE, Goris ML, Zhu HJ, Chen X, Bhise P, Sathi A, Sheikh F,
Moss RB. Changes in quantitative air trapping, pulmonary function,
and chest HRCT scores in CF children during a Pulmozyme interven-
tion study. Chest 2005;128:2327–2335.
6. Jones D, Shrimpton PC. Survey of CT practice in the UK: normalised
organ doses for X-ray computed tomography calculated using Monte
Carlo techniques. Harwell, UK: National Radiological Protection
Board; 1991. Available from: www.impactscan.org/ctdosimetry.htm
7. Radiation exposure in X-ray examinations. RadiologyInfo. January 10,
2005. Available from: http://www.radiologyinfo.org [c2005, Radiology
Society of North America, Inc].
8. Venkatraman R, Raman R, Raman B, Moss RB, Rubin GD, Mathers LH,
Robinson TE. Fully automated system for three-dimension bronchial
morphology analysis using volumetric multidector computed tomogra-
phy of the chest. J Digit Imaging 2006;19:132–139.
9. Robinson TE. High-resolution CT scanning: potential outcome measure.
Curr Opin Pulm Med 2004;10:537–541.
10. Brown RH, Mitzner W, Wagner E, Permutt S, Togias A. Airway disten-
tion with lung inflation measured by HRCT. Acad Radiol 2003;10:
1097–1103.
11. Long FR, Castile RG, Brody AS, Hogan MJ, Flucke RL, Filbrun DA,
McCoy KS. Lungs in infants and young children: improved thin-section
CT with a noninvasive controlled-ventilation technique: initial experi-
ence. Radiology 1999;212:588–593.
12. Long FR, Castile RG. Technique and clinical application of full-inflation
and end-exhalation controlled-ventilation chest CT in infants and
young children. Pediatr Radiol 2001;31:413–422.
13. Long FR. High-resolution CT of the lungs in infants and young children.
J Thorac Imaging 2001;16:184–196.
14. Long FR, Williams RS, Castile RG. Structural airway abnormalities in
infants and young children with cystic fibrosis. J Pediatr 2004;144:154–
161.
15. Martinez TM, Llapur CJ, Williams TH, Coates C, Gunderman R,
Cohen MD, Howenstine MS, Saba O, Coxson HO, Tepper RS. High-
resolution tomography imaging of airway disease in infants with cystic
fibrosis. Am J Respir Crit Care Med 2005;172:1133–1138.
16. Long FR, Williams RS, Adler BH, Castile RG. Comparison of quiet
breathing and controlled ventilation in the high-resolution CT assess-
ment of airway disease in infants with cystic fibrosis. Pediatr Radiol
2005;35:1075–1080.
17. Davis S, Fordham L, Brody AS, Noah TL, Retsch-Bogart GZ, Qaqish
BF, Yankaskas BC, Johnson RC, Leigh MW. Computed tomography
reflects lower airway inflammation and tracks changes in early cystic
fibrosis. Am J Respir Crit Care Med 2007;175:943–950.
18. Robinson TE, Leung AN, Moss RB, Blankenberg FG, al-Dabbagh H,
Northway WH. Standardized high-resolution CT of the lung using a
spirometer-triggered electron beam CT scanner. AJR Am J Roentgenol
1999;172:1636–1638.
19. Robinson TE, Leung AN, Northway WH, Blankenberg FG, Chan FP,
Bloch DA, Holmes TH, Moss RB. Composite spirometric-computed
tomography outcome measure in early cystic fibrosis lung disease. Am
J Respir Crit Care Med 2003;168:588–593.
20. Bhalla M, Turcios N, Aponte V, Jenkins M, Leitman BS, McCauley
DI, Naidich DP. Cystic fibrosis: scoring system with thin-section CT.
Radiology 1991;179:783–788.
21. Maffessanti M, Candusso M, Brizzi F, Piovesana F. Cystic fibrosis in
children: HRCT findings and distribution of disease. J Thorac Imaging
1996;11:27–38.
22. Shah RM, Sexauer W, Ostrum BJ, Fiel SB, Friedman AC. High-resolution
CT in the acute exacerbation of cystic fibrosis: evaluation of acute
Robinson: Chest CT Scanning Techniques in CF
findings, reversibility of those findings, and clinical correlation. AJR
Am J Roentgenol 1997;169:375–380.
23. Santamaria F, Grillo G, Guidi G, Rotondo A, Raia V, de Ritis G, Sarnelli
P, Caterino M, Greco L. Cystic fibrosis: when should high-resolution
computed tomography of the chest be obtained? Pediatrics 1998;101:
908–913.
24. Helbich TH, Heinz-Peer G, Eichler I, Wunderbaldinger P, Gotz M,
Wojnarowski C, Brasch RC, Herold CJ. Cystic fibrosis: CT assessment
of lung involvement in children and adults. Radiology 1999;213:537–
544.
25. Helbich TH, Heinz-Peer G, Fleischmann D, Wojnarowski C,
Wunderbaldinger P, Huber S, Eichler I, Herold CJ. Evolution of
CT findings in patients with cystic fibrosis. AJR Am J Roentgenol
1999;173:81–88.
26. Brody AS, Molina PL, Klein JS, Rothman BS, Ramagopal M, Swartz
DR. High-resolution computed tomography of the chest in children
with cystic fibrosis: support for use as an outcome surrogate. Pediatr
Radiol 1999;29:731–735.
27. Demirkazik FB, Ariyürek OM, Ozçelik U, Göçmen A, Hassanabad HK,
Kiper N. High resolution CT in children with cystic fibrosis: correlation
with pulmonary functions and radiographic scores. Eur J Radiol
2001;37:54–59.
28. Nasr SZ, Gordon D, Sakmar E, Yu X, Christodoulou E, Eckhardt BP,
Strouse PJ. High resolution computerized tomography of the chest
and pulmonary function testing in evaluating the effect of tobramycin
solution for inhalation in cystic fibrosis patients. Pediatr Pulmonol
2006;41:1129–1137.
29. Oikonomou A, Manavis J, Karagianni P, Tsanakas J, Wells AU, Hansell
DM, Papadopoulou F, Efremidis SC. Loss of FEV1 in cystic fibrosis:
correlation with HRCT features. Eur Radiol 2002;12:2229–2235.
30. Dakin CJ, Pereira JK, Henry RL, Wang H, Morton JR. Relationship
between sputum inflammatory markers, lung function, and lung pa-
thology on high-resolution computed tomography in children with
cystic fibrosis. Pediatr Pulmonol 2002;33:475–482.
31. de Jong PA, Ottink MD, Robben SG, Lequin MH, Hop WC, Hendriks
JJ, Pare PD, Tiddens HA. Pulmonary disease assessment in cystic
fibrosis: comparison of CT scoring systems and value of bronchial and
arterial dimension measurements. Radiology 2004;231:434–439.
32. de Jong PA, Nakano Y, Lequin MH, Mayo JR, Woods R, Pare PD,
Tiddens HA. Progressive damage on high-resolution computed tomog-
raphy despite stable lung function in cystic fibrosis. Eur Respir J 2004;
23:93–97.
33. Moss RB, Rodman D, Spencer LT, Aitken ML, Zeitlin PL, Waltz D,
Milla C, Brody AS, Clancy JP, Ramsey B. Repeated adeno-associated
315
virus serotype 2 aerosol-mediated cystic fibrosis transmembrane regu-
lator gene transfer to the lungs of patients with cystic fibrosis: a
multicenter, doubleblind, placebo-controlled trial. Chest 2004;125:509–
521.
34. Brody AS, Klein JS, Molina PL, Quan J, Bean JA, Wilmott RW. High-
resolution computed tomography in young patients with cystic fibrosis:
distribution of abnormalities and correlation with pulmonary function
tests. J Pediatr 2004;145:32–38.
35. Brody AS, Robinson TE, Knowles MR, LaVange LM, Engels JM. The
use of high-resolution CT in intervention studies of cystic fibrosis
[abstract 321]. Pediatr Pulmonol 2004;(Suppl 27):298.
36. Brody AS, Sucharew H, Campbell JD, Millard SP, Molina PL, Klein JS,
Quan J. Computed tomography correlates with pulmonary exacerba-
tions in children with cystic fibrosis. Am J Respir Crit Care Med 2005;
172:1128–1132.
37. Brody AS, Tiddens HA, Castile RG, Coxson HO, de Jong PA, Goldin
J, Huda W, Long FR, McNitt-Gray M, Rock M, et al. Computed
tomography in the evaluation of cystic fibrosis lung disease. Am J
Respir Crit Care Med 2005;172:1246–1252.
38. de Jong PA, Lindblad A, Rubin L, Hop WCJ, de Jongste JC, Brink M,
Tiddens HA. Progression of lung disease on computed tomography
and pulmonary function tests in children and adults with cystic fibrosis.
Thorax 2006;61:80–85.
39. Nasr SZ, Gordon D, Sakmar E, Yu X, Christodouiou E, Eckhardt BP,
Strouse PJ. High resolution computerized tomography of the chest
and pulmonary function testing in evaluating the effect of tobramycin
solution for inhalation in cystic fibrosis patients. Pediatr Pulmonol
2006;41:1129–1137.
40. Judge EP, Dodd JD, Masterson JB, Gallagher CG. Pulmonary abnormali-
ties on high-resolution CT demonstrate more rapid decline than FEV1
in adults with cystic fibrosis. Chest 2006;130:1424–1432.
41. Tiddens HA. Detecting early structural lung damage in cystic fibrosis.
Pediatr Pulmonol 2002;34:228–231.
42. Tiddens HA, de Jong PA. Update on the application of chest computed
tomography scanning to cystic fibrosis. Curr Opin Pulm Med 2006;12:
433–439.
43. Carroll JRD, Chandra A, Jones AS, Berend N, Magnussen JS, King GG.
Airway dimensions measured from micro-computed tomography and
high-resolution computed tomography. Eur Respir J 2006;28:712–720.
44. de Jong PA, Long FR, Nakano Y. Computed tomography dose and
variability of airway dimension measurements: how low can we go?
Pediatr Radiol 2006;36:1043–1047.
45. Robinson TE. Imaging of the chest in cystic fibrosis. Clin Chest Med
2007;28:405–421.