Ultrasonic spirometers

There are at least a half dozen companies that use an ultrasonic flowmeter in their spirometer. The first patent for an ultrasonic flowmeter was made in the 1970’s but it wasn’t until the 1990’s that the first ultrasonic spirometers came to market. The basic idea is fairly simple and that is to measure the transit time of ultrasonic pulses through flowing gas. Pulses that travel in the same direction the gas is flowing will take less time to travel a given distance, while pulses traveling against the direction of gas flow take a longer time.

This particular measurement process is called time-of-flight (as opposed to doppler shift) and has a relatively flat flow/signal curve and frequency response. An early design of this kind of flowmeter had the ultrasonic transducers sitting in the flow of gas, but this both impedes the flow of gas and is hard to clean. A transverse design was developed that put the transducers outside the path of gas flow and this configuration has been used in all ultrasonic spirometers.

Ultrasonic flowmeter

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Washout volume, transit time and DLCO

Recently while reviewing PFT reports I ran across a test from a patient who had been having spirometry, lung volume and DLCO tests performed at regular intervals for the last several years. Compared to the last several set of tests the most recent DLCO had decreased significantly while the FVC, FEV1 and TLC hadn’t changed. I took a closer look at the raw data from the DLCO test and when I did I saw that the washout volume was not correct.

Alveolar_Sample_Unadjusted_Cropped

Or more correctly, even though the washout volume matched the ATS/ERS standard for DLCO testing it was evident the expiratory gas sample was not taken from the alveolar plateau. The CO and CH4 concentrations at this point in the exhalation are higher than they are in the alveolar plateau and this means the reported DLCO was underestimated.

Alveolar_Sample_Adjusted_Cropped

When I re-adjusted the washout so the gas sample was taken from the alveolar plateau, the DLCO went from 18.56 ml/min/mmHg to 22.26 ml/min/mmHg, which is a 20% increase and far more in line with the patient’s prior DLCO test results.

This, however, increased the washout volume from 0.75 L to 1.34 L. Why was the washout volume so high? The answer is it probably wasn’t.

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