PFTs on YouTube

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A friend recently sent me the links to several YouTube videos on pulmonary function testing. I’ve spent some time off and on over the last year looking at YouTube videos and in particular I’ve been looking for ones that can be used as part of technician education. Maybe I’ve set the bar too high but all too often I’ve been disappointed and frustrated with what I’ve found. One reason for this is that many videos are aimed at other audiences than technicians (i.e. medical students, physicians, patients). Another reason is that too often only simple concepts are presented, often in rote fashion and often without good visual explanations (c’mon, these are videos after all, not podcasts). A final reason is that sometimes they’re outdated, misleading or just plain wrong.

Still, even the flawed videos can be useful. Sometimes this is because they occasionally explain some concepts well; sometimes despite being simplistic they present a good overview; and sometimes because their mistakes can serve as points for discussion. I’ve tried to select videos that have at least some potential for use in technician education.

John B. West Respiratory Physiology Lectures

Based primarily on his classic textbook, ‘Respiratory Physiology’ (which should be on everybody’s bookshelf). Not 100% perfect but this is what many of the other videos should aspire to be. Many complex concepts explained using simple examples. Lots of interesting pictures and illustrations. Should be part of every technician’s education.

  1. Structure and Function
  2. Ventilation
  3. Blood Gas Transport
  4. Acid-Base Balance
  5. Diffusion
  6. Pulmonary Blood Flow
  7. Pulmonary Gas Exchange, Part 1
  8. Pulmonary Gas Exchange, Part 2
  9. Mechanics of Breathing, Part 1
  10. Mechanics of Breathing, Part 2
  11. Control of Ventilation
  12. Defense Systems of the Lung
  13. Respiration under Stress
  14. Respiration at the Limit

Allan Prost

A series of casual video lectures on pulmonary function testing. Some are flawed by shaky camera handling and poor audio. The PFT test videos cover a lot of the basic material needed for good testing. They’re light on physiology but an adequate starting point for demonstrating test maneuvers to new technicians. All tests are performed using MedGraphics equipment. The product introductions are adequate for orienting a tech to new equipment.

PFT Tests:

  1. Slow Vital Capacity
  2. Forced Vital Capacity
  3. DLCO Single Breath
  4. MVV
  5. N2 washout
  6. Single Breath N2 washout
  7. Plethysmography

Product Introductions:

MedCram PFT

I found this series of lectures frustrating. Using animated slides they explained some important concepts with simple and clear examples. Having said that, it was flawed because a fair amount of the information presented was outdated and occasionally even incorrect. The interpretation algorithm was particularly quirky. I felt that if this was presented in 1980 it would have been considered state of the art but there’s been a lot of water under the bridge since then.

 Intro to the PFT Lab

  1. Introduction to PFTs
  2. Concepts
  3. Flow-Volume Loops
  4. Lung volumes
  5. DLCO
  6. Interpretation, part 1
  7. Interpretation, part 2

Strong Medicine

Essentially a PowerPoint slideshow with voiceover. More current than MedCram but flawed because the narrator often just read the slides and basic concepts were often poorly explained. Did a good job of following the spirit of the ATS/ERS interpretation algorithm.

Note: For reasons that are unclear this set of videos appears several times from different sources. Strong Medicine however, is dated earlier than the others and for this reason receives the credit for them here.

  1. Introduction
  2. Spirometry
  3. Lung volumes
  4. DLCO
  5. Summary and practice cases

Peter Sloane MD.

Series on Pulmonary Function Interpretation using animated slides. Most concepts presented in rote fashion using text and voiceover with either no or an inadequate visual explanation of underlying physiology or techniques. Complex issues were occasionally presented but often jumped through much too quickly. Almost no explanation of testing errors except very quickly when discussing interpretation pitfalls. Voiceover too often read from the slides. Still covered all the basics though.

  1. Definitions, interpretation of spirometry and flow-volume loops.
  2. Lung volumes and diffusion capacity
  3. Pitfalls in interpretation / common patterns
  4. Practice questions & explanations

TTUHSCtv

PowerPoint slideshow of text and flow-volume loops with voiceover. Detailed review of reports but approach to interpretation is outdated and does not follow current ATS/ERS guideline. Some incorrect information.

  1. PFT Interpretation part 1 (normal)
  2. PFT Interpretation part 2 (obstruction)
  3. PFT Interpretation part 3 (restriction)

Khanacademymedicine

Videoed drawings with voiceover. Khan Academy has a large number of videos on physiology and anatomy presented by different lecturers. Concepts are presented a bit simplistically but clearly and thoroughly, nonetheless.

professorfink

Numerous classroom physiology lectures. Video using an overhead projector with text and diagrams. Basic, college-level A&P that’s better than average.

Arzoo Sadiqi

Overhead shots of drawings with voiceover. Quick overview of physiology that was somewhat superficial but material was otherwise mostly correct.

ERS Education

I included because it’s from the European Respiratory Society. Disappointing considering the source but a banner indicates this was a demo so it’s an edited version (full version is behind the ERS paywall). A quick overview of spirometry with peculiar and poorly explained volume-time curves. Various flow-volume were shown and labeled but with no explanation about their contour. An explanation of patient prep was cut off before showing an actual spirometry test.

CompleWare

Showed the spirometry procedure with spirometer calibration, patient explanation and test performance. Quickly explained criteria for an acceptable quality test with some examples. Hit all the high points but there was little in the way of detailed explanations and it went through its material very quickly.

Morgan Scientific

Training videos on how to perform tests using various Morgan Scientific test systems. All are professionally produced and many of the subjects covered are applicable to other manufacturer’s equipment.

Carefusion

Professionally produced training videos but highly oriented towards the Vyntus system. Surprisingly, other than sales pitches I was unable to find videos of any other Carefusion PFT equipment.

  1. Vyntus Spiro hardware review and set up
  2. Vyntus Spiro calibration
  3. Vyntus Spiro FVC Measurement
  4. Vyntus Spiro Review and Reporting

MGC Diagnostics

Training videos. Casual format. Surprisingly, other than sales pitches I was unable to find videos of any other MGC Diagnostics PFT equipment (at least from MGC Diagnostics).

NDD

Training videos. A mixture of casual lectures and animation. Professionally produced, although some are better than others.

CPUSB Human Performance Lab

A series of casual video lectures, with slides, on calibrating and using various systems. Shaky video. Covers the basics for specific systems.

Allan Dunphy

Classroom lectures. Sometimes shaky video. Covers the basics.

NHSWestminster

Spirometry (SVC and FVC) with a patient is demonstrated. Video with slides. Includes patient questions, explanations to patient, test procedure.

MisteryGanz

Video of equations and graphics being written on paper. Covers a complex series of equations and concepts but explanations are limited and some concepts are missing. No discussion of testing issues and errors.

Darren Roesch

Video of equations and graphics being highlighted on paper. Covers a complex series of equations and concepts but explanations are limited and some concepts are missing. No discussion of testing issues and errors.

Deb Akers

Casual lecture showing how to calibrate VMax gas analyzers. Shaky video but covers the subject.

VC Respiratory

Shows basic calibration procedure of an electronic spirometer. Shaky video and poor audio but shows the basics.

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There are an awful lot of videos I haven’t included. Too many people seem to think that going through the motions of performing a PFT of one kind or another in front of a camera, without any particular explanation of anatomy, physiology, gas laws or technical details of the test, somehow makes an acceptable video (although in some instances this is probably okay for patient-oriented videos).

There are also too many videos about pulmonary function testing created by individuals who seem to have read a few textbooks and then feel qualified to (superficially) teach the subject. Too few videos are created by individuals with hands-on experience and what’s most often missing is any significant discussion of technical details, potential testing errors and their effects on results. I was particularly disappointed that all of the videos that purported to teach interpretation almost universally did so using 80% of predicted as the LLN and used the GOLD FEV1/FVC ratio criteria. I found nothing discussing the LLN or Z score.  

There there also were many reasonably good videos that touched on pulmonary anatomy and physiology but I had to draw the line somewhere so I settled for ones that in my opinion seemed most relevant to educating pulmonary function technicians.

Watching all these videos has made me think about what should be part of a technician’s education, however. This list is certainly open to discussion but I think that a curriculum needs to include following topics:

Gases.

Gas laws. Aerodynamics. Turbulence. Molecular diffusion. BTPS/STPD/ATPD. Partial pressures. Barometric pressure. Viscosity. Solubility. Temperature.

Anatomy

Upper airway (larynx and pharynx). Airway anatomy including stucture of airway wall, acinus and alveoli. Thorax including ribcage, diaphragm and pleura. Arterial and venous circulation.

Physiology

Compliance. Pressure-volume. Equal pressure point. Cardiac output. Fick’s law. A-a gradient. Dead space. Vd/Vt. Qs/Qt.

Test system technology.

Volume displacement spirometers. Flow sensors (pneumotachs, hot-wire anemometers, turbines, ultrasonics). Transducers and A-D conversion. Gas analyzers. Flow-volume loops. Plethysmographs. Helium dilution FRC. N2 washout FRC. Single Breath N2 washout. Oximeters.

ATS/ERS/ACCP/OSHA standards

Spirometry. Lung volumes. DLCO. 6MWT. Methacholine challenge. MIP/MEP. CPET. DLNO.

Test quality

Back extrapolation. Expiratory time. Plateaus. Leaks. Hesitations and coughs. Calibration. Biological QC. Levey-Jennings charts.

Lung diseases

Asthma. COPD. Bronchitis. Bronchiectasis. Cystic Fibrosis. Pulmonary fibrosis. Sarcoidosis. ALS. Tracheomalacia.

Interpretation

ATS/ERS algorithm. Reference equations. LLN and ULN. Z score.

Patient relations

Mouthpieces. Noseclips. Hygiene. Explaining tests. What to do when things go wrong.

There are a lot of subjects here for which there are no corresponding videos (or at least none that I’d recommend). If anybody has aspirations of producing their own YouTube videos on pulmonary function testing – please!!! No more spirometry videos, or if you must at least tackle some of the technical details. Instead choose one of these subjects that hasn’t already been covered.

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