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tions between aging and the diaphragm.17) Total diaphragm volume evaluation by a new measure-ment method could be useful in clarifying any such relationships. Furthermore, in patients with a disease of the diaphragm, morphological abnormal-ities due to aging or disuse, and decreased muscle volume, aggressive respiratory rehabilitation is expected to improve diaphragm function, treat-ment results, and quality of life. In the future, this method could be used to evaluate respiratory func-tion in surgical treatment and ICU patients. To avoid the issue of additional radiation exposure, CT data obtained during preoperative evaluations could be used.This study has some limitations, including its small sample size (five subjects). However, it was possible to evaluate the diaphragm volume in all cases. Furthermore, the proposed measurement method involves radiation exposure, and it is still unknown whether the measured volume reflects the actual volume of the diaphragm. Additionally, technical standardization is necessary. Finally, these results may not be generalizable to other populations.In conclusion, this study is the first to standardize the method for measuring the total diaphragm volume and examine the reproducibility and validity of the new method. The diaphragm could be selec-tively extracted and reconstructed. Measurement of the total diaphragm muscle volume using a workstation to reconstruct a stereoscopic image is feasible and highly reproducible. This technique can be reliably employed to evaluate diaphragm volume, thickness, and morphology.Availability of Data and MaterialsAll data generated or analyzed during this study are included in this article.AcknowledgmentsWe would like to thank Shigeki Aoki, Ph.D., a professor at the Department of Radiology, Juntendo University; Yosuke Kogure, Ph.D., a radiological technologist at the Department of Radiology, Juntendo University; and Shuko Nojiri, Ph.D., asso-ciate professor at the Juntendo University Medical Technology Innovation Center, for their help in conducting the research. We also thank Editage (www.editage.com) for their writing support. 1) Ratnovsky A, Elad D, Halpern P: Mechanics of respira-tory muscles. Respir Physiol Neurobiol, 2008; 163: 82-89. 2) Siafakas NM, Mitrouska I, Bouros D, Georgopoulos D: Surgery and the respiratory muscles. Thorax, 1999; 54: 458-465. 3) Kitts JB: The preoperative assessment: who is respon-sible? Can J Anaesth, 1997; 44: 1232-1236. 4) Wrigge H, Uhlig U, Zinserling J, et al: The effects of different ventilatory settings on pulmonary and systemic inflammatory responses during major surgery. Anesth Analg, 2004; 98: 775-781, table of contents. 5) Wrigge H, Uhlig U, Baumgarten G, et al: Mechanical ventilation strategies and inflammatory responses to cardiac surgery: a prospective randomized clinical trial. Intensive Care Med, 2005; 31: 1379-1387. 6) ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group, Mackle D, Bellomo R, et al: Conservative Oxygen Therapy during Mechanical Ventilation in the ICU. N Engl J Med, 2020; 382: 989-998. 7) Shanely RA, Zergeroglu MA, Lennon SL, et al: Mechan-ical ventilation-induced diaphragmatic atrophy is asso-ciated with oxidative injury and increased proteolytic activity. Am J Respir Crit Care Med, 2002; 166: 1369-1374. 8) Schepens T, Verbrugghe W, Dams K, et al: The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study. Crit Care, 2015; 19: 422. 9) MacIntyre NR, Epstein SK, Carson S, et al: Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest, The authors received no financial support for the research.All authors contributed to the conception of study design and data acquisition. AA, TM (TMorita), and TM (TMori) analyzed and inter-preted the data and critically revised the manu-script for important intellectual content. AA was responsible for the investigation, methodology, drafting of the manuscript, validation, and visual-ization. TM (TMorita) was responsible for the project administration. AA (AAmano) critically revised the manuscript for important intellectual content and supervised the study. All authors read and approved the final manuscript.The authors declare that there are no conflicts of interest.489FundingAuthor contributionsConflicts of interest statementReferences

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