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1234532a Type A ICCs using an absolute agreement definition.b The estimator was the same, regardless of whether the interaction effect was present.A two-way random effects model was applied with both participant effects and measure effects as random.Abbreviations: CI, confidence interval; df, degrees of freedom ICC, intraclass correlation coefficient.was excellent for Observer #1, based on a Cron-bach’s alpha of 0.992, single-measurement ICC of 0.982 (95% CI: 0.998-0.922), and average-measure-ment ICC of 0.994 (95% CI: 0.999-0.972) (Table 6). The interrater agreement, summarized in Table 7, showed a high correlation between the measure-ments taken by the two observers between different workstation software, with a Cronbach’s alpha of 0.984, single-measurement ICC of 0.956 (95% CI: 0.995-0.635), and average-measurement ICC of 0.978 (95% CI: 0.998-0.776).We performed an accurate evaluation of diaphragm morphology and volume using 3D-CT. Although, to our knowledge, this is not the first study to measure the total volume of the diaphragm20-22), Abbreviation: SD, standard deviation.MeasurementICCSingleAverage0.9820.994A one-way random effects model was applied with participant effects as random.Abbreviations: CI, confidence interval; df, degrees of freedom; ICC, intraclass correlation coefficient.MeasurementICCaSingleAverage0.956b0.978Table 5　 Detailed results and average diaphragm volume across all measurements (first, Table 6　Intraclass correlation coefficients for observer #1 by workstation software AZETable 7　Interrater agreement between measurements recorded by the two observers between different workstationsn=5First (cm3)309.6238.3227.7258.6230.5252.934MeanSD95% CILower0.9220.972Upper0.9980.99995% CILower0.6350.776Upper0.9950.998second, and third) for observer #1 by workstation software AZEthis study was the first to standardize the method for measuring the total diaphragm volume and examine the reproducibility and validity of the new method. Using 3D-CT, we were able to confirm the morphological evaluation of the entire diaphragm, including its form, thinness, and volume.The diaphragm muscle volume reported in a previous study21) was smaller than the mean diaphragm volume measured by our method. Although this could be due to differences in patient medical history and characteristics, as well as the software used, the difference in measurement method is also likely to be a major reason. Image analysis software generally use measurement methods that involve semi-automatic tracking and selection. This increases measurement speed, but the anatomy of the diaphragm makes it is difficult Third (cm3)301.7238.9229.5260.0227.7251.631Mean (cm3)306.6237.5226.6263.8227.5252.434df21010P-value<0.001<0.001Cronbach’s alphadf244P-value<0.001<0.001Cronbach’s alphaReliability statisticsn0.992Reliability statisticsn0.984487Observer #1(AZE)Second (cm3)308.4235.3222.6272.8224.2252.737F-test with true value=0Value162.011162.011df144F-test with true value=0Value63.90263.902df144Discussion