In vivo quantification of human lung dose response relationship

Purpose: To implement a new non-invasive in-vivo assay to compute the dose-response relationship following radiationinduced injury to normal lung tissue, using computed tomography (CT) scans of the chest. Methods and Materials: Follow-up volumetric CT scans were acquired in patients with metastatic tumors to the lung treated using stereotactic radiation therapy. The images reveal a focal region of fibrosis corresponding to the high-dose region and no observable long-term damage in distant sites. For each pixel in the follow-up image the treatment dose and the change in apparent tissue density was compiled. For each of 12 pre-selected dose levels the average pixel tissue density change was computed and fit to a two-parameter dose-response model. The sensitivity of the resulting fits to registration error was also quantified. Results: Complete in vivo dose-response relationships in human normal lung tissue were computed. Increasing radiation sensitivity was found with larger treatment volume. Radiation sensitivity increased also over time up to 12 months, but decreased at later time points. The time-course of dose response correlated with the time-course of levels of circulating IL-1α, TGFβ and MCP-1. The method was found to be robust to registration errors up to 3 mm. Conclusions: This approach for the first time enables the quantification of the full range dose response relationship in human subjects. The method may be used to assess quantitatively the efficacy of various agents thought to illicit radiation protection to the lung.