Quantitative Estimation of Radiation-induced Lung Damage by CT

The risk of radiation-induced lung injury is a major cause of limitation of radiation dose in different types of radiation therapy of the chest area. Studies of these injuries are aimed at the detection of unknown factors responsible for their development. However, as already described, modern approaches to the assessment of lung lesions are mainly qualitative or semi-quantitative. This leads to uncertainty in the diagnosis of early and late post-radiation changes and hence a lack of standardization studies. Accordingly, this in turn reduces the importance of imaging in CT study a continuous spectrum of gravity of basic biological manifestations of radiation damage in the form of spectral density changes of the lung tissue. All these drawbacks are eliminated in the quantitative analysis of CT data. The main peaks of research in this area accounts for the last 5-6 years. To describe the post-radiation damage to different authors used different quantitative approaches. This time dependence of the changes, and changes in the average density of the light dose, and the variability of the standard deviation of average density, and quantitative assessment of local structural changes and even a software image analysis. This also occurred variability patients contingent on the underlying disease, the difference of methods and techniques of radiation therapy, and combination of radiation with chemotherapy drugs. In all studies, there was a large interindividual variation magnitudes of “effect”, which has not been analyzed by the authors themselves, but can be caused by both genetic characteristics of patients and histopathology induced complications themselves, which in turn confirms the importance and relevance of the quantitative analysis in CT ray study of lung damage.

лучевые повреждения легких, лучевая терапия, диагностика, компьютерная томография, количественная оценка, radiation-induced lung damage, radiation pneumonitis, CT scan, quantitative assessment, diagnostics

1. Нуднов Н.В., Сотников В.М., Леденев В.В., Барышникова Д.В. Возможности качественной оценки лучевых повреждений легких методом компьютерной томографии. Медицинская визуализация. 2016; 1: 39-47.

2. Van Dyk J., Hill R.P. Post-irradiation lung density changes measured by computerized tomography. Int. J. Radiat. Oncol. Biol. Phys. 1983; 9 (6): 847-852.

3. Lee J.Y., Shank B., Bonfiglio P., Reid A. CT analysis of lung density changes in patients undergoing total body irradiation prior to bone marrow transplantation. J. Comput. Assist. Tomogr. 1984; 8 (5): 885-891.

4. el-Khatib E.E., Freeman C.R., Rybka W.B. et al. T he use of CT densitometry to predict lung toxicity in bone marrow transplant patients. Int. J. Radiat. Oncol. Biol. Phys. 1989; 16 (1): 85-94.

5. Bogner L., Schiessl I., Spiegler W. et al. Diagnostic methods for the quantification of radiation injuries of the lungs. Rofo. 2000; 172 (5): 472-476.

6. Palma D.A., van Sornsen de Koste J., Verbakel W.F. et al. Lung density changes after stereotactic radiotherapy: a quantitative analysis in 50 patients. Int. J. Radiat. Oncol. Biol. Phys. 2011; 81 (4): 974-978.

7. Phernambucq E.C., Palma D.A., Vincent A. et al. Time and dose-related changes in radiological lung density after concurrent chemoradiotherapy for lung cancer. Lung Cancer. 2011; 74 (3): 451-456.

8. Palma D.A., van Sornsen de Koste J.R., Verbakel W.F. Senan S. A new approach to quantifying lung damage after stereotactic body radiation therapy. Acta Oncol. 2011; 50 (4): 509-517.

9. Mattonen S.A., Palma D.A., Haasbeek C.J. Distinguishing radiation fibrosis from tumour recurrence after stereotactic ablative radiotherapy (SABR) for lung cancer: a quantitative analysis of CT density changes. Acta Oncol. 2013; 52 (5): 910-918.

10. De Ruysscher D., Sharifi H., Defraene G. et al. Quantification of radiation-induced lung dam age with CT scans: the possible benefit for radiogenomics. Acta Oncol. 2013; 52 (7): 1405-1410.

11. Sharifi H., van Elmpt W., Oberije C. et al. Quantification of CT-assessed radiation-induced lung damage in lung cancer patients treated with or without chemotherapy and cetuximab. Acta Oncol. 2015; 23: 1-7.

12. Ghobadi G., Hogeweg L.E., Faber H. et al. Quantifying local radiation-induced lung damage from computed tomography. Int. J. Radiat. Oncol. Biol. Phys. 2010; 76 (2): 548-556.

13. Ghobadi G., Wiegman E.M., Langendijk J.A. et al. A new CT-based method to quantify radiation-induced lung damage in patients. Radiother. Oncol. 2015; 117 (1): 4-8.

14. Cunliffe A.R., Al-Hallaq H.A., Labby Z.E. et al. Lung texture in serial thoracic CT scans: assessment of change introduced by image registration. Med. Phys. 2012; 39 (8): 4679-4690.

15. Cunliffe A.R., Armato S.G. 3rd, Fei X.M. et al. Lung texture in serial thoracic CT scans: registration-based methods to compare anatomically matched regions. Med. Phys. 2013; 40 (6): 061906.

16. Cunliffe A.R., Armato S.G. 3rd, Straus C. et al. Lung texture in serial thoracic CT scans: correlation with radiologistdefined severity of acute changes following radiation therapy. Phys. Med. Biol. 2014; 59 (18): 5387-5398.

17. Cunliffe A.R., Armato S.G. 3rd, Castillo R. et al. Lung texture in serial thoracic computed tomography scans: correlation of radiomics-based features with radiation therapy dose and radiation pneumonitis development. Int. J. Radiat. Oncol. Biol. Phys. 2015; 91 (5): 1048-1056.

18. Cunliffe A.R., Contee C., Armato S.G. 3rd et al. Effect of deformable registration on the dose calculated in radiation therapy planning CT scans of lung cancer patients. Med. Phys. 2015; 42 (1): 391-399.

19. Cunliffe A.R., White B., Justusson J. et al. Comparison of Two Deformable Registration Algorithms in the Presence of Radiologic Change Between Serial Lung CT Scans. J. Digit. Imaging. 2015; 28 (6): 755-760.

20. Bernchou U., Hansen O., Schytte T. et al. Prediction of lung density changes after radiotherapy by cone beam computed tomography response markers and pretreatment factors for non-small cell lung cancer patients. Radiother. Oncol. 2015; 117 (1): 17-22.

21. Diot Q., Marks L.B., Bentzen S.M. et al. Comparison of radiation-induced normal lung tissue density changes for patients from multiple institutions receiving conventional or hypofractionated treatments. Int. J. Radiat. Oncol. Biol. Phys. 2014; 89 (3): 626-632.

22. Defraene G., van Elmpt W., Crijns W. et al. CT characteristics allow identification of patient-specific susceptibility for radiation-induced lung damage. Radiother. Oncol. 2015; 117 (1): 29-35.