Abstract Introduction Portable Dynamic Digital Radiography (pDDR; Konica-Minolta, Inc.) is an advanced chest radiography technique capturing 15 sequential images per second, enabling visualization of pulmonary motion, ventilation, and perfusion without significantly increasing radiation dose. Using high-sensitivity detectors and motion analysis software, pDDR provides quantitative metrics of lung and diaphragmatic function beyond conventional radiography.As part of our clinical trial, with this bedside FDA-approved technology for ICU, four cases illustrate the clinical utility and range of quantitative assessments achievable with pDDR. Case Descriptions We present four cases: (1) normal diaphragmatic excursion, (2) one-sided paralysis with synchronous motion, (3) asynchronous motion, and (4) paradoxical movement. Motion-tracking measured excursion amplitude, velocity, and synchrony for the hemidiaphragms. Portable DDR was performed without adverse events, confirming feasibility and safety in the ICU. High-quality images characterized diaphragmatic excursion, synchrony, and motion phase. Edge detection technology identified and tracked the movement of the diaphragms, and manual adjustments were made if needed.First, pDDR clearly visualized both diaphragms, revealing symmetrical diaphragmatic excursion with coordinated, in-phase movement (Fig 1A/1B). Second, findings indicated complete right hemidiaphragm paralysis (3.2 mm) with preserved left-sided motion (27.2 mm, Fig 2). Third, early imaging displayed normal right diaphragmatic motion (14.4 mm) but impaired (Fig 3A) and out-of-phase motion on the left (6.4 mm, Fig 3B), which improved seven months later (Rt: 26.0, Lt: 25.2 mm, Fig 3C/3D) as both moved synchronously. This highlights pDDR’s capability to monitor functional recovery over time. Fourth, paradoxical left diaphragmatic motion was observed, providing dynamic evidence of severe dysfunction undetectable on static imaging (Fig 4), while the right diaphragm showed high-normal excursion (25.6 mm). Discussion Portable Dynamic Digital Radiography (pDDR) offers a safe, quantitative, and real-time method for evaluating diaphragmatic motion and lung dynamics in ICU patients. This early clinical experience demonstrates that pDDR can help distinguish between normal, paralyzed, asynchronous, and paradoxical diaphragmatic motion, while also tracking functional improvement over time. This highlight pDDR’s potential role as a bedside, quantitative imaging tool for assessing diaphragmatic dysfunction, characterizing its nature, monitoring post-surgical recovery, and guiding ventilatory management in the ICU. Also, this novel technology provides diagnostic information beyond that available from standard portable chest radiography, bedside ultrasonography or computed tomography. Our broader clinical trial will further define pDDR’s diagnostic accuracy and clinical impact.The study was supported by a research grant from Konica-Minolta, Inc. References: Nishino Hatabu, M. and Frendl G. Portable Dynamic Digital Radiography (pDDR) in bronchial stenosis after lung transplant. Radiology. November 11, 2025; 317(2):e251612. This abstract is funded by: Konica Minolta
Folbe et al. (Fri,) studied this question.