Imaging
Radiation Lung Injury
- Preliminary Diagnosis: Radiation Lung Injury
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing radiation lung injury.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing radiation lung injury.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Radiation Lung Injury
I. What imaging technique is first-line for this diagnosis?
Computed tomography (CT) chest without contrast
II. Describe the advantages and disadvantages of this technique for diagnosing radiation lung injury.
Advantages
Diagnostic of radiation lung injury.
Can better differentiate radiation lung injury from tumor recurrence or infection than other imaging modalities.
Shows the ground glass opacities related to early radiation lung injury, even when chest radiography is normal.
Better shows radiation lung injury confined to a radiation treatment portal than radiography.
Disadvantages
Exposes the patient to more ionizing radiation than radiography.
III. What are the contraindications for the first-line imaging technique?
Contraindicated in pregnant women, especially during the first and second trimesters.
IV. What alternative imaging techniques are available?
High resolution CT (HRCT) chest without contrast
Chest radiography (CXR)
Positron emission tomography (PET)/CT chest,
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing radiation lung injury.
HRCT chest without contrast
Advantages
Optimal tool for visualization and diagnosis of radiation lung injury.
Can differentiate radiation lung injury from tumor recurrence or infection.
Disadvantages
Standard CT chest is usually just as diagnostic as HRCT.
HRCT exposes the patient to ionizing radiation.
CXR with posteroanterior (PA) and lateral projections
Advantages
May be diagnostic of radiation lung injury.
Can show manifestations of early and chronic radiation lung injury, and can track the progression of disease.
Disadvantages
May be negative during early radiation lung injury, even when CT shows the disease.
Less sensitive for delineation of radiation lung injury from tumor recurrence or infection.
PET/CT chest
Advantages
Very sensitive for identifying tumor recurrence within chronic radiation lung injury/scarring.
Great tool for staging and follow-up of chest malignancy.
Disadvantages
Early radiation lung injury (i.e., first few weeks) can have increased radiotracer activity and mimic tumor recurrence on PET/CT.
Expensive.
Exposes the patient to more ionizing radiation than radiography.
Requires more patient cooperation than CT.
Requires good blood sugar control, and may have to be rescheduled if the patient is hyperglycemic.
Has to be delayed for a few hours after the patient receives insulin therapy.
VI. What are the contraindications for the alternative imaging techniques?
HRCT
Contraindicated in pregnant women, especially in the first and second trimesters.
CXR
Has no significant contraindication. Consent may be required for pregnant patients at some institutions.
PET/CT
Contraindicated in pregnant women, especially in the first and second trimesters.
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