Radiation-induced Lung Disease and the Impact of Radiation Methods on Imaging Features
Kyung Joo Park, MD,
Jin Young Chung, MD ,
Mi Son Chun, MD and
Jung Ho Suh, MD
1 From the Departments of Radiology (K.J.P., J.Y.C., J.H.S.) and Therapeutic Radiology (M.S.C.), Ajou University Medical Center, San 5, Wonchon, Paldal, Suwon 442-749, South Korea. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 24, 1999; revision requested April 6 and received June 2; accepted June 8. Address reprint requests to K.J.P.
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Figure 1a. Evolution of radiation-induced lung disease in a 65-year-old man with non-small cell lung cancer. (a) Pretreatment chest radiograph shows a nodule in the left upper lobe (arrow). (b) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined, patchy haziness in the irradiated regions of both upper lungs (arrows). (c, d) Radiographs obtained 6 months (c) and 1 year (d) after completion of therapy demonstrate evolution of the disease with increasing volume loss, homogeneity of opacity, and sharpness of lateral margins.
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Figure 1b. Evolution of radiation-induced lung disease in a 65-year-old man with non-small cell lung cancer. (a) Pretreatment chest radiograph shows a nodule in the left upper lobe (arrow). (b) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined, patchy haziness in the irradiated regions of both upper lungs (arrows). (c, d) Radiographs obtained 6 months (c) and 1 year (d) after completion of therapy demonstrate evolution of the disease with increasing volume loss, homogeneity of opacity, and sharpness of lateral margins.
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Figure 1c. Evolution of radiation-induced lung disease in a 65-year-old man with non-small cell lung cancer. (a) Pretreatment chest radiograph shows a nodule in the left upper lobe (arrow). (b) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined, patchy haziness in the irradiated regions of both upper lungs (arrows). (c, d) Radiographs obtained 6 months (c) and 1 year (d) after completion of therapy demonstrate evolution of the disease with increasing volume loss, homogeneity of opacity, and sharpness of lateral margins.
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Figure 1d. Evolution of radiation-induced lung disease in a 65-year-old man with non-small cell lung cancer. (a) Pretreatment chest radiograph shows a nodule in the left upper lobe (arrow). (b) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined, patchy haziness in the irradiated regions of both upper lungs (arrows). (c, d) Radiographs obtained 6 months (c) and 1 year (d) after completion of therapy demonstrate evolution of the disease with increasing volume loss, homogeneity of opacity, and sharpness of lateral margins.
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Figure 2. Non-small cell lung cancer in a 47-year-old man. CT scan obtained 3 months after completion of radiation therapy shows ground-glass attenuation in the irradiated paramediastinal region of the right lung.
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Figure 3. Non-small cell lung cancer in a 55-year-old man. CT scan obtained 4 months after completion of radiation therapy shows patchy consolidation in the irradiated region of the right lung.
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Figure 4a. Adenocarcinoma of the lung in a 50-year-old woman. The patient was treated with a radiation dose of 50 Gy after undergoing right upper and middle lobectomy. (a) CT scan obtained 3 months after completion of therapy shows discrete consolidation in the right lower lobe conforming to the radiation portal. (b) CT scan obtained at the same level 5 months later demonstrates solid consolidation with a sharp, straight lateral edge (arrows).
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Figure 4b. Adenocarcinoma of the lung in a 50-year-old woman. The patient was treated with a radiation dose of 50 Gy after undergoing right upper and middle lobectomy. (a) CT scan obtained 3 months after completion of therapy shows discrete consolidation in the right lower lobe conforming to the radiation portal. (b) CT scan obtained at the same level 5 months later demonstrates solid consolidation with a sharp, straight lateral edge (arrows).
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Figure 5a. Portals used for irradiation of lung cancer. (a, b) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the upper lobes. Note the unilateral (a) and bilateral (b) supraclavicular fields. (c, d) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the lower lobes. The supraclavicular areas are included if there is a gross mediastinal tumor in the lower lobe (d). (e, f) Portal radiographs demonstrate portals used for irradiation of small cell lung cancer, including a limited portal (e) and a larger portal that includes both hilar regions, the entire mediastinum, and the supraclavicular region (f).
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Figure 5b. Portals used for irradiation of lung cancer. (a, b) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the upper lobes. Note the unilateral (a) and bilateral (b) supraclavicular fields. (c, d) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the lower lobes. The supraclavicular areas are included if there is a gross mediastinal tumor in the lower lobe (d). (e, f) Portal radiographs demonstrate portals used for irradiation of small cell lung cancer, including a limited portal (e) and a larger portal that includes both hilar regions, the entire mediastinum, and the supraclavicular region (f).
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Figure 5c. Portals used for irradiation of lung cancer. (a, b) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the upper lobes. Note the unilateral (a) and bilateral (b) supraclavicular fields. (c, d) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the lower lobes. The supraclavicular areas are included if there is a gross mediastinal tumor in the lower lobe (d). (e, f) Portal radiographs demonstrate portals used for irradiation of small cell lung cancer, including a limited portal (e) and a larger portal that includes both hilar regions, the entire mediastinum, and the supraclavicular region (f).
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Figure 5d. Portals used for irradiation of lung cancer. (a, b) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the upper lobes. Note the unilateral (a) and bilateral (b) supraclavicular fields. (c, d) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the lower lobes. The supraclavicular areas are included if there is a gross mediastinal tumor in the lower lobe (d). (e, f) Portal radiographs demonstrate portals used for irradiation of small cell lung cancer, including a limited portal (e) and a larger portal that includes both hilar regions, the entire mediastinum, and the supraclavicular region (f).
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Figure 5e. Portals used for irradiation of lung cancer. (a, b) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the upper lobes. Note the unilateral (a) and bilateral (b) supraclavicular fields. (c, d) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the lower lobes. The supraclavicular areas are included if there is a gross mediastinal tumor in the lower lobe (d). (e, f) Portal radiographs demonstrate portals used for irradiation of small cell lung cancer, including a limited portal (e) and a larger portal that includes both hilar regions, the entire mediastinum, and the supraclavicular region (f).
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Figure 5f. Portals used for irradiation of lung cancer. (a, b) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the upper lobes. Note the unilateral (a) and bilateral (b) supraclavicular fields. (c, d) Portal radiographs demonstrate portals used for irradiation of non-small cell lung cancer in the lower lobes. The supraclavicular areas are included if there is a gross mediastinal tumor in the lower lobe (d). (e, f) Portal radiographs demonstrate portals used for irradiation of small cell lung cancer, including a limited portal (e) and a larger portal that includes both hilar regions, the entire mediastinum, and the supraclavicular region (f).
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Figure 6a. Squamous cell carcinoma in a 62-year-old man. (a) Pretreatment chest radiograph shows a cavitary mass in the right lower lobe. The patient was treated with a radiation dose of 50 Gy with portals that included lung tissue adjacent to the mass as well as the lower mediastinum (cf Fig 5c). (b) Radiograph obtained 4 months after completion of radiation therapy shows faint, ill-defined areas of increased opacity around the cavitary mass (arrows).
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Figure 6b. Squamous cell carcinoma in a 62-year-old man. (a) Pretreatment chest radiograph shows a cavitary mass in the right lower lobe. The patient was treated with a radiation dose of 50 Gy with portals that included lung tissue adjacent to the mass as well as the lower mediastinum (cf Fig 5c). (b) Radiograph obtained 4 months after completion of radiation therapy shows faint, ill-defined areas of increased opacity around the cavitary mass (arrows).
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Figure 7a. Lung changes in a 41-year-old man with adenocarcinoma treated with mediastinal and supraclavicular radiation portals. (a) Pretreatment chest radiograph shows a mass in the right lower lobe as well as right paratracheal lymph nodes (arrow). (b, c) CT scans obtained 2 months after completion of radiation therapy show patchy consolidation and ground-glass attenuation in the lower lobes (b) and both lung apices (c) conforming to the supraclavicular portals. (d) Chest radiograph obtained 18 months after b and c demonstrates advanced radiation fibrosis in the right lung.
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Figure 7b. Lung changes in a 41-year-old man with adenocarcinoma treated with mediastinal and supraclavicular radiation portals. (a) Pretreatment chest radiograph shows a mass in the right lower lobe as well as right paratracheal lymph nodes (arrow). (b, c) CT scans obtained 2 months after completion of radiation therapy show patchy consolidation and ground-glass attenuation in the lower lobes (b) and both lung apices (c) conforming to the supraclavicular portals. (d) Chest radiograph obtained 18 months after b and c demonstrates advanced radiation fibrosis in the right lung.
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Figure 7c. Lung changes in a 41-year-old man with adenocarcinoma treated with mediastinal and supraclavicular radiation portals. (a) Pretreatment chest radiograph shows a mass in the right lower lobe as well as right paratracheal lymph nodes (arrow). (b, c) CT scans obtained 2 months after completion of radiation therapy show patchy consolidation and ground-glass attenuation in the lower lobes (b) and both lung apices (c) conforming to the supraclavicular portals. (d) Chest radiograph obtained 18 months after b and c demonstrates advanced radiation fibrosis in the right lung.
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Figure 7d. Lung changes in a 41-year-old man with adenocarcinoma treated with mediastinal and supraclavicular radiation portals. (a) Pretreatment chest radiograph shows a mass in the right lower lobe as well as right paratracheal lymph nodes (arrow). (b, c) CT scans obtained 2 months after completion of radiation therapy show patchy consolidation and ground-glass attenuation in the lower lobes (b) and both lung apices (c) conforming to the supraclavicular portals. (d) Chest radiograph obtained 18 months after b and c demonstrates advanced radiation fibrosis in the right lung.
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Figure 8a. Pulmonary tuberculosis mimicking radiation pneumonitis in a 47-year-old man with lung cancer in the right middle lobe. (a) Radiograph obtained 4 months after completion of radiation therapy shows ill-defined haziness in the right lung (open arrows) within the radiation portal. Patchy, nodular areas of increased opacity are seen in the left upper lung (arrowheads). (b) CT scan through the carina demonstrates nodular and tree-in-bud lesions (arrowhead) in the left upper lobe and in the superior segment of the left lower lobe, findings that are consistent with tuberculosis. The ground-glass attenuation seen in the right upper lobe (arrows) represents radiation pneumonitis.
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Figure 8b. Pulmonary tuberculosis mimicking radiation pneumonitis in a 47-year-old man with lung cancer in the right middle lobe. (a) Radiograph obtained 4 months after completion of radiation therapy shows ill-defined haziness in the right lung (open arrows) within the radiation portal. Patchy, nodular areas of increased opacity are seen in the left upper lung (arrowheads). (b) CT scan through the carina demonstrates nodular and tree-in-bud lesions (arrowhead) in the left upper lobe and in the superior segment of the left lower lobe, findings that are consistent with tuberculosis. The ground-glass attenuation seen in the right upper lobe (arrows) represents radiation pneumonitis.
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Figure 9a. Radiation pneumonitis in a 60-year-old man with recurrent lung cancer following left lower lobectomy. The unusual location of the disease reflects the use of oblique portals. (a) Localization radiograph shows a right anterior oblique mediastinal portal. A radiation dose of 24 Gy was administered with right anterior and left posterior oblique beam angles after irradiation with 30 Gy in an anteroposterior-posteroanterior direction. (b) Radiograph obtained 4 weeks after completion of radiation therapy shows ill-defined haziness in the upper and middle left lung. (c, d) CT scans obtained through the aortic arch (c) and at the subcarina level (d) at the same time as b demonstrate asymmetric, patchy consolidation anterolaterally in the right lung and posterolaterally in the left lung conforming to the shape of the right anterior and left posterior oblique portals.
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Figure 9b. Radiation pneumonitis in a 60-year-old man with recurrent lung cancer following left lower lobectomy. The unusual location of the disease reflects the use of oblique portals. (a) Localization radiograph shows a right anterior oblique mediastinal portal. A radiation dose of 24 Gy was administered with right anterior and left posterior oblique beam angles after irradiation with 30 Gy in an anteroposterior-posteroanterior direction. (b) Radiograph obtained 4 weeks after completion of radiation therapy shows ill-defined haziness in the upper and middle left lung. (c, d) CT scans obtained through the aortic arch (c) and at the subcarina level (d) at the same time as b demonstrate asymmetric, patchy consolidation anterolaterally in the right lung and posterolaterally in the left lung conforming to the shape of the right anterior and left posterior oblique portals.
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Figure 9c. Radiation pneumonitis in a 60-year-old man with recurrent lung cancer following left lower lobectomy. The unusual location of the disease reflects the use of oblique portals. (a) Localization radiograph shows a right anterior oblique mediastinal portal. A radiation dose of 24 Gy was administered with right anterior and left posterior oblique beam angles after irradiation with 30 Gy in an anteroposterior-posteroanterior direction. (b) Radiograph obtained 4 weeks after completion of radiation therapy shows ill-defined haziness in the upper and middle left lung. (c, d) CT scans obtained through the aortic arch (c) and at the subcarina level (d) at the same time as b demonstrate asymmetric, patchy consolidation anterolaterally in the right lung and posterolaterally in the left lung conforming to the shape of the right anterior and left posterior oblique portals.
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Figure 9d. Radiation pneumonitis in a 60-year-old man with recurrent lung cancer following left lower lobectomy. The unusual location of the disease reflects the use of oblique portals. (a) Localization radiograph shows a right anterior oblique mediastinal portal. A radiation dose of 24 Gy was administered with right anterior and left posterior oblique beam angles after irradiation with 30 Gy in an anteroposterior-posteroanterior direction. (b) Radiograph obtained 4 weeks after completion of radiation therapy shows ill-defined haziness in the upper and middle left lung. (c, d) CT scans obtained through the aortic arch (c) and at the subcarina level (d) at the same time as b demonstrate asymmetric, patchy consolidation anterolaterally in the right lung and posterolaterally in the left lung conforming to the shape of the right anterior and left posterior oblique portals.
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Figure 10a. Right breast cancer in a 56-year-old woman who had undergone local excision and irradiation. (a, b) Portal radiographs demonstrate a tangential beam radiation field (a) and a supraclavicular field (b). (c) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the right middle lung (solid arrows) and right apex (open arrows). (d, e) Thin-section CT scans obtained 4 months later demonstrate consolidation with a sharp posterior margin peripherally in the right upper lobe conforming to the shape of the tangential beam radiation portal (d), as well as consolidation and ground-glass attenuation in the right apex conforming to the supraclavicular portal (e).
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Figure 10b. Right breast cancer in a 56-year-old woman who had undergone local excision and irradiation. (a, b) Portal radiographs demonstrate a tangential beam radiation field (a) and a supraclavicular field (b). (c) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the right middle lung (solid arrows) and right apex (open arrows). (d, e) Thin-section CT scans obtained 4 months later demonstrate consolidation with a sharp posterior margin peripherally in the right upper lobe conforming to the shape of the tangential beam radiation portal (d), as well as consolidation and ground-glass attenuation in the right apex conforming to the supraclavicular portal (e).
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Figure 10c. Right breast cancer in a 56-year-old woman who had undergone local excision and irradiation. (a, b) Portal radiographs demonstrate a tangential beam radiation field (a) and a supraclavicular field (b). (c) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the right middle lung (solid arrows) and right apex (open arrows). (d, e) Thin-section CT scans obtained 4 months later demonstrate consolidation with a sharp posterior margin peripherally in the right upper lobe conforming to the shape of the tangential beam radiation portal (d), as well as consolidation and ground-glass attenuation in the right apex conforming to the supraclavicular portal (e).
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Figure 10d. Right breast cancer in a 56-year-old woman who had undergone local excision and irradiation. (a, b) Portal radiographs demonstrate a tangential beam radiation field (a) and a supraclavicular field (b). (c) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the right middle lung (solid arrows) and right apex (open arrows). (d, e) Thin-section CT scans obtained 4 months later demonstrate consolidation with a sharp posterior margin peripherally in the right upper lobe conforming to the shape of the tangential beam radiation portal (d), as well as consolidation and ground-glass attenuation in the right apex conforming to the supraclavicular portal (e).
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Figure 10e. Right breast cancer in a 56-year-old woman who had undergone local excision and irradiation. (a, b) Portal radiographs demonstrate a tangential beam radiation field (a) and a supraclavicular field (b). (c) Radiograph obtained 3 months after completion of radiation therapy shows ill-defined haziness in the lateral part of the right middle lung (solid arrows) and right apex (open arrows). (d, e) Thin-section CT scans obtained 4 months later demonstrate consolidation with a sharp posterior margin peripherally in the right upper lobe conforming to the shape of the tangential beam radiation portal (d), as well as consolidation and ground-glass attenuation in the right apex conforming to the supraclavicular portal (e).
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Figure 11a. Recurrent breast cancer in the chest wall in a 39-year-old woman who had undergone partial mastectomy and axillary dissection. (a) Localization radiograph shows an anteroposterior portal used for internal mammary and chest wall irradiation. (b) Drawing illustrates isodose distribution of chest wall tangential beam and internal mammary radiation fields. (c) Radiograph obtained 6 months after completion of therapy shows chronic radiation-induced change in the left upper lung conforming to the internal mammary field. (d) Thin-section CT scan shows discrete consolidation with chronic fibrotic change in the paramediastinal region of the left upper lobe.
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Figure 11b. Recurrent breast cancer in the chest wall in a 39-year-old woman who had undergone partial mastectomy and axillary dissection. (a) Localization radiograph shows an anteroposterior portal used for internal mammary and chest wall irradiation. (b) Drawing illustrates isodose distribution of chest wall tangential beam and internal mammary radiation fields. (c) Radiograph obtained 6 months after completion of therapy shows chronic radiation-induced change in the left upper lung conforming to the internal mammary field. (d) Thin-section CT scan shows discrete consolidation with chronic fibrotic change in the paramediastinal region of the left upper lobe.
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Figure 11c. Recurrent breast cancer in the chest wall in a 39-year-old woman who had undergone partial mastectomy and axillary dissection. (a) Localization radiograph shows an anteroposterior portal used for internal mammary and chest wall irradiation. (b) Drawing illustrates isodose distribution of chest wall tangential beam and internal mammary radiation fields. (c) Radiograph obtained 6 months after completion of therapy shows chronic radiation-induced change in the left upper lung conforming to the internal mammary field. (d) Thin-section CT scan shows discrete consolidation with chronic fibrotic change in the paramediastinal region of the left upper lobe.
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Figure 11d. Recurrent breast cancer in the chest wall in a 39-year-old woman who had undergone partial mastectomy and axillary dissection. (a) Localization radiograph shows an anteroposterior portal used for internal mammary and chest wall irradiation. (b) Drawing illustrates isodose distribution of chest wall tangential beam and internal mammary radiation fields. (c) Radiograph obtained 6 months after completion of therapy shows chronic radiation-induced change in the left upper lung conforming to the internal mammary field. (d) Thin-section CT scan shows discrete consolidation with chronic fibrotic change in the paramediastinal region of the left upper lobe.
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Figure 12a. Squamous cell carcinoma in the lower esophagus of a 64-year-old man. (a) Esophagogram shows a mass in the lower esophagus (arrows). (b) Portal radiograph shows a narrow mediastinal portal that includes the left supraclavicular area. (c) Radiograph obtained 6 months after completion of therapy shows dense areas of increased opacity in the medial portion of the left lung with volume loss (arrows). (d, e) CT scans obtained at the same time as c demonstrate solid consolidation with a sharp lateral margin (arrows) in the paramediastinal area of the apex (d) and lower lobe of the left lung (e).
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Figure 12b. Squamous cell carcinoma in the lower esophagus of a 64-year-old man. (a) Esophagogram shows a mass in the lower esophagus (arrows). (b) Portal radiograph shows a narrow mediastinal portal that includes the left supraclavicular area. (c) Radiograph obtained 6 months after completion of therapy shows dense areas of increased opacity in the medial portion of the left lung with volume loss (arrows). (d, e) CT scans obtained at the same time as c demonstrate solid consolidation with a sharp lateral margin (arrows) in the paramediastinal area of the apex (d) and lower lobe of the left lung (e).
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Figure 12c. Squamous cell carcinoma in the lower esophagus of a 64-year-old man. (a) Esophagogram shows a mass in the lower esophagus (arrows). (b) Portal radiograph shows a narrow mediastinal portal that includes the left supraclavicular area. (c) Radiograph obtained 6 months after completion of therapy shows dense areas of increased opacity in the medial portion of the left lung with volume loss (arrows). (d, e) CT scans obtained at the same time as c demonstrate solid consolidation with a sharp lateral margin (arrows) in the paramediastinal area of the apex (d) and lower lobe of the left lung (e).
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Figure 12d. Squamous cell carcinoma in the lower esophagus of a 64-year-old man. (a) Esophagogram shows a mass in the lower esophagus (arrows). (b) Portal radiograph shows a narrow mediastinal portal that includes the left supraclavicular area. (c) Radiograph obtained 6 months after completion of therapy shows dense areas of increased opacity in the medial portion of the left lung with volume loss (arrows). (d, e) CT scans obtained at the same time as c demonstrate solid consolidation with a sharp lateral margin (arrows) in the paramediastinal area of the apex (d) and lower lobe of the left lung (e).
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Figure 12e. Squamous cell carcinoma in the lower esophagus of a 64-year-old man. (a) Esophagogram shows a mass in the lower esophagus (arrows). (b) Portal radiograph shows a narrow mediastinal portal that includes the left supraclavicular area. (c) Radiograph obtained 6 months after completion of therapy shows dense areas of increased opacity in the medial portion of the left lung with volume loss (arrows). (d, e) CT scans obtained at the same time as c demonstrate solid consolidation with a sharp lateral margin (arrows) in the paramediastinal area of the apex (d) and lower lobe of the left lung (e).
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Figure 13a. Non-Hodgkin lymphoma in a 20-year-old woman. (a) Portal radiograph shows a mantle field. (b, c) CT scans obtained 6 months after completion of radiation therapy show minimal radiation-induced change with linear, streaky shadows in the paramediastinal regions of the lungs (b) as well as in both apices (c).
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Figure 13b. Non-Hodgkin lymphoma in a 20-year-old woman. (a) Portal radiograph shows a mantle field. (b, c) CT scans obtained 6 months after completion of radiation therapy show minimal radiation-induced change with linear, streaky shadows in the paramediastinal regions of the lungs (b) as well as in both apices (c).
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Figure 13c. Non-Hodgkin lymphoma in a 20-year-old woman. (a) Portal radiograph shows a mantle field. (b, c) CT scans obtained 6 months after completion of radiation therapy show minimal radiation-induced change with linear, streaky shadows in the paramediastinal regions of the lungs (b) as well as in both apices (c).
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Figure 14a. Non-Hodgkin lymphoma in a 35-year-old woman. (a) Radiograph obtained 4 weeks after completion of radiation therapy shows alveolar consolidation in the medial zones of both lungs. Pleural effusion is also seen. A tentative diagnosis of radiation pneumonitis was made, and steroid therapy was initiated. (b) Radiograph obtained 2 months later shows chronic radiation change with fibrosis and volume loss. Note the symmetric bilateral lesion with extension to the apices.
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Figure 14b. Non-Hodgkin lymphoma in a 35-year-old woman. (a) Radiograph obtained 4 weeks after completion of radiation therapy shows alveolar consolidation in the medial zones of both lungs. Pleural effusion is also seen. A tentative diagnosis of radiation pneumonitis was made, and steroid therapy was initiated. (b) Radiograph obtained 2 months later shows chronic radiation change with fibrosis and volume loss. Note the symmetric bilateral lesion with extension to the apices.
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Figure 15. Portal used for irradiation of non-small cell lung cancer. Portal radiograph shows an involved-field portal that was used to treat a peripheral tumor with chest wall invasion. Because there was no evidence of lymphadenopathy, the tumor was treated without hilar or mediastinal fields.
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Copyright © 2000 by the Radiological Society of North America.
