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DOI: 10.1148/rg.244035220
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RadioGraphics 2004;24:998

EDUCATION EXHIBIT

Invited Commentary1

James E. Marks, MD

1 Department of Radiology, Missouri Baptist Medical Center, St Louis, Missouri

In the preceding article, Choi et al address one of the more common and important topics in diagnostic imaging today, the follow-up appearance of the subacute and late effects of radiation on the lung. Just as diagnostic radiologists often have little or no clinical information, they often have little or no understanding about how a patient was irradiated when interpreting a radiograph or CT scan that shows radiation change. A portal image of the anatomy irradiated and a CT scan showing the distribution of radiation dose in the patient along with the different beam trajectories would be most helpful to those who try to explain the findings on a follow-up radiograph or CT scan.

The diagnostic radiologist needs to know that radiation beams can damage transit tissues between the site of entry and the target and that these beams produce greater effects on tissue at points of intersection within the body due to accumulation of radiation dose. Most understand that the effects of radiation are greater for larger than smaller doses, but they also need to know that accelerated delivery of radiation is more injurious than standard fractionation with 1.8–2 Gy per day. Just as these details are helpful to the radiation oncologist who wants to know what effects a course of radiation has had on tissues, so too would they be useful to the diagnostic radiologist.

Needed is a "reverse" picture archiving and communication system (R-PACS) to give the diagnostic radiologist a detailed understanding of how a patient was irradiated. Once DICOM (Digital Imaging and Communications in Medicine)–compatible servers are developed for departments of radiation oncology, it will be an easy matter to transmit portal images, radiation treatment plans, dose prescriptions, and radiation dose distributions to departments of diagnostic radiology to help diagnostic radiologists understand the images they are being asked to interpret.


Related Article

Effects of Radiation Therapy on the Lung: Radiologic Appearances and Differential Diagnosis
Yo Won Choi, Reginald F. Munden, Jeremy J. Erasmus, Kyung Joo Park, Woo Kyung Chung, Seok Chol Jeon, and Choong-Ki Park
RadioGraphics 2004 24: 985-997. [Abstract] [Full Text] [PDF]




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