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Radiation-Induced Lung Disease
Sonia L. Betancourt Cuellar, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Radiation-induced lung disease (RILD)
          • Definitions

            • Radiation therapy (RT) uses ionizing radiation to control cell growth by damaging DNA of cancerous tissue leading to cellular death
              • Treatment/palliation of thoracic neoplasms: Lung, breast, and esophageal cancers; thymic epithelial neoplasms; lymphoma; malignant pleural mesothelioma (MPM)
            • Conventional 2DRT uses 2 parallel beams with opposed directions (anteroposterior and posteroanterior)
            • New RT techniques have been developed in order to increase dose to target lesion and decrease dose to surrounding structures
              • 3D image reconstructed from CT data is used to determine target volume; multiple beams are used to conform target and deliver maximal radiation to neoplasm
                • 3D conformal RT (3DCRT): Each radiation beam is shaped to fit profile of target volume (previously, radiation treatment matched height and width of target lesion)
                  • 4D conformal RT uses respiratory gating
                • Intensity-modulated RT (IMRT): Next generation of 3DCRT; allows more precise conformation to 3D shape by modulating intensity of radiation beam in multiple small volumes
                • Stereotactic body RT (SBRT): Delivers hypofractionated high radiation dose to treat early non-small cell lung cancer (NSCLC)
                • Proton therapy (PT): Radiation dose is delivered to certain depth with minimal dose beyond target lesion; useful for neoplasms close to mediastinum

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Pastis NJ Jr et al: Assessing the usefulness of 18F-fluorodeoxyglucose PET-CT scan after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Chest. 146(2):406-11, 2014
                                      2. Benveniste MF et al: New era of radiotherapy: an update in radiation-induced lung disease. Clin Radiol. 68(6):e275-90, 2013
                                      3. Chargari C et al: Complications of thoracic radiotherapy. Presse Med. 42(9 Pt 2):e342-51, 2013
                                      4. Larici AR et al: Lung abnormalities at multimodality imaging after radiation therapy for non-small cell lung cancer. Radiographics. 31(3):771-89, 2011
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Radiation-induced lung disease (RILD)
                                              • Definitions

                                                • Radiation therapy (RT) uses ionizing radiation to control cell growth by damaging DNA of cancerous tissue leading to cellular death
                                                  • Treatment/palliation of thoracic neoplasms: Lung, breast, and esophageal cancers; thymic epithelial neoplasms; lymphoma; malignant pleural mesothelioma (MPM)
                                                • Conventional 2DRT uses 2 parallel beams with opposed directions (anteroposterior and posteroanterior)
                                                • New RT techniques have been developed in order to increase dose to target lesion and decrease dose to surrounding structures
                                                  • 3D image reconstructed from CT data is used to determine target volume; multiple beams are used to conform target and deliver maximal radiation to neoplasm
                                                    • 3D conformal RT (3DCRT): Each radiation beam is shaped to fit profile of target volume (previously, radiation treatment matched height and width of target lesion)
                                                      • 4D conformal RT uses respiratory gating
                                                    • Intensity-modulated RT (IMRT): Next generation of 3DCRT; allows more precise conformation to 3D shape by modulating intensity of radiation beam in multiple small volumes
                                                    • Stereotactic body RT (SBRT): Delivers hypofractionated high radiation dose to treat early non-small cell lung cancer (NSCLC)
                                                    • Proton therapy (PT): Radiation dose is delivered to certain depth with minimal dose beyond target lesion; useful for neoplasms close to mediastinum

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • Nuclear Medicine Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Pastis NJ Jr et al: Assessing the usefulness of 18F-fluorodeoxyglucose PET-CT scan after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Chest. 146(2):406-11, 2014
                                                                          2. Benveniste MF et al: New era of radiotherapy: an update in radiation-induced lung disease. Clin Radiol. 68(6):e275-90, 2013
                                                                          3. Chargari C et al: Complications of thoracic radiotherapy. Presse Med. 42(9 Pt 2):e342-51, 2013
                                                                          4. Larici AR et al: Lung abnormalities at multimodality imaging after radiation therapy for non-small cell lung cancer. Radiographics. 31(3):771-89, 2011