4-Dimensional computed tomography-based ventilation and compliance images for quantification of radiation-induced changes in pulmonary function.
Sharifi H, Brown S, McDonald GC, Chetty IJ, and Zhong H. 4-Dimensional computed tomography-based ventilation and compliance images for quantification of radiation-induced changes in pulmonary function. J Med Imaging Radiat Oncol 2019; Epub ahead of print.
J Med Imaging Radiat Oncol
INTRODUCTION: 4-Dimensional computed tomography (4DCT)-based ventilation imaging is a promising technique for evaluating pulmonary function, but lung elasticity and mechanics are usually not part of the ventilation image analysis. In this study we demonstrate a 4DCT-based imaging technique that can be used to calculate regional lung compliance changes after radiotherapy (RT).
METHODS: Six lung cancer patients were included in this study. Four of the patients had 4DCT images acquired pre-RT, 3 and 9 months post-RT. Ventilation and compliance were calculated from the deformable image registration (DIR) of 4DCTs, performed from the end-inhale to the end-exhale breathing phase. Regional compliance was defined as the ratio of volumetric variation and associated stress in each voxel, representing lung elasticity and computed using a FEM-based framework. Ventilation, compliance and CT density were calculated for all pre-RT and post-RT 4DCTs and evaluation metrics were computed.
RESULTS: Average CT density changes were 13.6 ± 11.4HU after 3 months and 26.9 ± 15.8HU after 9 months. Ventilation was reduced at 3 months, but improved at 9 months in regions with dose ≥ 35 Gy, encompassing about 10% of the lung volume; compliance was reduced at both time-points. Radiation dose ≥ 35 Gy caused major change in lung density and ventilation, which was higher than that previously reported in the literature (i.e. 24 Gy).
CONCLUSION: Lung tissue response is diverse with respect to CT density, ventilation and compliance. Combination of ventilation and compliance with CT density could be beneficial for understanding radiation-induced lung damage and consequently could help develop improved treatment protocols for lung cancer patients.
ePub ahead of print