Original Article

The use of isodose levels to interpret radiation induced lung injury: a quantitative analysis of computed tomography changes

Miriam A. Knoll, Mary Salvatore, Ren Dih Sheu, Abraham D. Knoll, Sarah L. Kerns, Yeh-Chi Lo, Kenneth E. Rosenzweig


Background: Patients treated with stereotactic body radiation therapy (SBRT) for lung cancer are often found to have radiation-induced lung injury (RILI) surrounding the treated tumor. We investigated whether treatment isodose levels could predict RILI.
Methods: Thirty-seven lung lesions in 32 patients were treated with SBRT and received post-treatment follow up (FU) computed tomography (CT). Each CT was fused with the original simulation CT and treatment isodose levels were overlaid. The RILI surrounding the treated lesion was contoured. The RILI extension index [fibrosis extension index (FEI)] was defined as the volume of RILI extending outside a given isodose level relative to the total volume of RILI and was expressed as a percentage.
Results: Univariate analysis revealed that the planning target volume (PTV) was positively correlated with RILI volume at FU: correlation coefficient (CC) =0.628 and P<0.0001 at 1st FU; CE =0.401 and P=0.021 at 2nd FU; CE =0.265 and P=0.306 at 3rd FU. FEI −40 Gy at 1st FU was significantly positively correlated with FEI −40 Gy at subsequent FU’s (CC =0.689 and P=6.5×10−5 comparing 1st and 2nd FU; 0.901 and P=0.020 comparing 2nd and 3rd FU. Ninety-six percent of the RILI was found within the 20 Gy isodose line. Sixty-five percent of patients were found to have a decrease in RILI on the second 2nd CT.
Conclusions: We have shown that RILI evolves over time and 1st CT correlates well with subsequent CTs. Ninety-six percent of the RILI can be found to occur within the 20 Gy isodose lines, which may prove beneficial to radiologists attempting to distinguish recurrence vs. RILI.

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