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
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Diagnostic of radiation lung injury.
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Can better differentiate radiation lung injury from tumor recurrence or infection than other imaging modalities.
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Shows the ground glass opacities related to early radiation lung injury, even when chest radiography is normal.
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Better shows radiation lung injury confined to a radiation treatment portal than radiography.
Disadvantages
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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?
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High resolution CT (HRCT) chest without contrast
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Chest radiography (CXR)
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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
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Optimal tool for visualization and diagnosis of radiation lung injury.
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Can differentiate radiation lung injury from tumor recurrence or infection.
Disadvantages
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Standard CT chest is usually just as diagnostic as HRCT.
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HRCT exposes the patient to ionizing radiation.
CXR with posteroanterior (PA) and lateral projections
Advantages
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May be diagnostic of radiation lung injury.
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Can show manifestations of early and chronic radiation lung injury, and can track the progression of disease.
Disadvantages
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May be negative during early radiation lung injury, even when CT shows the disease.
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Less sensitive for delineation of radiation lung injury from tumor recurrence or infection.
PET/CT chest
Advantages
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Very sensitive for identifying tumor recurrence within chronic radiation lung injury/scarring.
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Great tool for staging and follow-up of chest malignancy.
Disadvantages
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Early radiation lung injury (i.e., first few weeks) can have increased radiotracer activity and mimic tumor recurrence on PET/CT.
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Expensive.
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Exposes the patient to more ionizing radiation than radiography.
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Requires more patient cooperation than CT.
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Requires good blood sugar control, and may have to be rescheduled if the patient is hyperglycemic.
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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
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Contraindicated in pregnant women, especially in the first and second trimesters.
CXR
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Has no significant contraindication. Consent may be required for pregnant patients at some institutions.
PET/CT
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Contraindicated in pregnant women, especially in the first and second trimesters.
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