Evidence map›Paper›PMID 42265327›Full record

ArticleCommunications medicine2026

Deep learning approach for probabilistic pulmonary function estimation from chest X-ray and peak expiratory flow rate.

Christoph Killing, Maximilian Wekerle, Jayne S Sutherland, Mohammad Rassool, Lindsay Zurba, Olena Ivanova, Salome Charalambous, Celso Khosa, Robert S Wallis, Michael Hoelscher and 5 more

Abstract read
In one paragraph

Article in Communications medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Christoph KillingInstitute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany. christoph.killing@med.uni-muenchen.de.ORCID http://orcid.org/0009-0008-9849-8316
Maximilian WekerleInstitute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.ORCID http://orcid.org/0000-0002-9173-4872
Jayne S SutherlandVaccines and Immunity Theme, Medical Research Council Unit The Gambia at LSHTM, Fajara, The Gambia.
Mohammad RassoolClinical HIV Research Unit (CHRU), Wits Health Consortium (WHC), Health Science Research Office (HSRO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Lindsay ZurbaEducation for Health Africa, Durban, South Africa.
Olena IvanovaInstitute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Salome CharalambousThe Aurum Institute, Johannesburg, South Africa.
Celso KhosaInstituto Nacional de Saúde, Marracuene, Mozambique.
Robert S WallisThe Aurum Institute, Johannesburg, South Africa.ORCID http://orcid.org/0000-0001-6152-5183
Michael HoelscherInstitute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.ORCID http://orcid.org/0000-0002-7642-1835
Claire CalderwoodClinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
Brian AllwoodDivision of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa.
Noemi CastellettiInstitute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Andrea RachowInstitute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
TB Sequel Consortium

Funding

Bundesministerium für Bildung und Forschung (Federal Ministry of Education and Research) 01KA2223BDeutsches Zentrum für Infektionsforschung (German Center for Infection Research) 01KA2108
6 · The paper itself

Abstract

backgroundSpirometry remains the gold standard for assessing pulmonary function. Deep learning models have demonstrated potential for estimating measurements from chest X-rays (CXR). We aim to effectively address anatomical variability and integrate probabilistic reasoning to enhance estimation reliability near diagnostic thresholds.

methodsWe developed a probabilistic machine learning framework to estimate the forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) as measured through spirometry. Estimations use morphologically regularized CXRs and anthropometric-normalized peak expiratory flow rate (PEFR) as proxy for volumetric information unavailable in imaging. By estimating FEV1 and FVC z-scores, we decouple appearance from anatomic variability. We demonstrate our method on a multi-national cohort of pulmonary tuberculosis patients exhibiting diverse structural abnormalities and ventilatory impairments.

resultsUsing ensembles of neural networks, we analyze 982 CXR and spirometry pairs from 568 individuals. The best model achieves an area under curve (AUC) of 0.879 (FEV1; 99%CI 0.876, 0.881) and 0.853 (FVC; 99%CI 0.850, 0.856) in identifying moderate or severe lung-function impairment on a previously unseen test-set, signifying an AUC improvement of 0.144 (FEV1) and 0.118 (FVC) over previous methods. When allowing up to 10% of samples to remain unclassified due to uncertainty, AUC further rises to 0.894 (0.891, 0.896) and 0.857 (0.854, 0.860), respectively. Our method performs robustly across diverse impairment types and CXR pathologies.

conclusionsOur study shows that decoupling anatomical variability from functional assessment improves lung function estimation. Incorporation of probabilistic modeling improved diagnostic reliability around a decision threshold. Therefore, our system offers a promising approach to practical lung function estimation in settings where spirometry is unavailable.

Identifiers

PMID42265327
PMCPMC13249966

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.