title: Lung deformations and radiation-induced regional lung collapse in patients treated with stereotactic body radiation therapy.
abstract: OBJECTIVE
  To differentiate radiation-induced fibrosis from regional lung collapse outside of the high dose region in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors.
  
  
  METHODS
  Lung deformation maps were computed from pre-treatment and post-treatment computed tomography (CT) scans using a point-to-point translation method. Fifty anatomical landmarks inside the lung (vessel or airway branches) were matched on planning and follow-up scans for the computation process. Two methods using the deformation maps were developed to differentiate regional lung collapse from fibrosis: vector field and Jacobian methods. A total of 40 planning and follow-ups CT scans were analyzed for 20 lung SBRT patients.
  
  
  RESULTS
  Regional lung collapse was detected in 15 patients (75%) using the vector field method, in ten patients (50%) using the Jacobian method, and in 12 patients (60%) by radiologists. In terms of sensitivity and specificity the Jacobian method performed better. Only weak correlations were observed between the dose to the proximal airways and the occurrence of regional lung collapse.
  
  
  CONCLUSIONS
  The authors presented and evaluated two novel methods using anatomical lung deformations to investigate lung collapse and fibrosis caused by SBRT treatment. Differentiation of these distinct physiological mechanisms beyond what is usually labeled "fibrosis" is necessary for accurate modeling of lung SBRT-induced injuries. With the help of better models, it becomes possible to expand the therapeutic benefits of SBRT to a larger population of lung patients with large or centrally located tumors that were previously considered ineligible.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045.
authors.forename: Quentin
authors.initials: Q
authors.lastname: Diot
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045.
authors.forename: Brian
authors.initials: B
authors.lastname: Kavanagh
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045.
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Vinogradskiy
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado 80045.
authors.forename: Kavita
authors.initials: K
authors.lastname: Garg
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045.
authors.forename: Laurie
authors.initials: L
authors.lastname: Gaspar
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045.
authors.forename: Moyed
authors.initials: M
authors.lastname: Miften
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000528:radiation effects; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging* / Q000209:etiology*; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D017564:Radiation Pneumonitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D016634:Radiosurgery / Q000009:adverse effects*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome