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. 2020 Sep 29;18(3):1559325820962600.
doi: 10.1177/1559325820962600. eCollection 2020 Jul-Sep.

Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement

Ruhollah Ghahramani-Asl  1   2 , Pejman Porouhan  3 , Mohammad Mehrpouyan  1 , James S Welsh  4 , Edward J Calabrese  5 , Rachna Kapoor  6 , Gaurav Dhawan  7 , Seyed Alireza Javadinia  8
Affiliations

Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement

Ruhollah Ghahramani-Asl et al. Dose Response. .

Abstract

Background and purpose: To assess the feasibility of a treatment planning system in localizing, contouring, and targeting lung lesions along with an evaluation of volume indices of lung involvement in patients with COVID-19 pneumonia.

Methods: We evaluated 10 patients with PCR-confirmed COVID-19 pneumonia. The CT images were imported into the ISOgray® treatment planning system to anatomically define and contour the volumes of the pulmonary lesions, the lungs, and other nearby organs.

Results: The ratio of lung lesion volume to lung volume in this study was 0.11 ± 0.13 (11.13%). The highest mean biosynthesis ratio of lung lesions was 0.36. The ratio of lesion volume in the left lung of patients with the highest volume of involvement, was 0.44, and the ratio of lesion volume in the right lung of these patients was 0.27 (approximately 1.5 times more in the left lung than the right lung). On average, CTDIvol and DLP for all patients studied in our study were 11.22 ± 2.47 mGy and 354.20 ± 65.11 mGy.cm.

Conclusion: We reported the feasibility of using a treatment planning system in localizing COVID-19 pulmonary lesions and its validity in the volumetric assessment of infected lung regions.

Keywords: 3 dimensional (3D) conformal radiation therapy; COVID-19; SARS-CoV-2; acute respiratory distress syndrome (ARDS); low dose radiotherapy; treatment planning system.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Schematic view for thoracic CT organs contouring of a patient. Contouring can be done manually, semi-automatic and automatically.
Figure 2.
Figure 2.
A single transaxial thoracic CT image with bone window (A) and with lung window (B) displayed. Pixel values in window width ranged from 1800 to 2200 for bone and 300 to 1100 for lung.
Figure 3.
Figure 3.
The images of the first COVID-19 patient with low grade lung involvement. The volumes of lesions in the left and right lungs were 28.64 and 76.05 cm3 respectively. The acquired sum ratio for this volume involvements was 0.07 (or 7%).
Figure 4.
Figure 4.
The images of the eighth COVID-19 patient with moderate grade lung involvement. The volumes of lesions in the left and right lungs were 207.95 and 249.54 cm3 respectively. The acquired sum ratio for this volume involvements was 0.20 (or 20%).
Figure 5.
Figure 5.
The images of the fifth COVID-19 patient with severe grade lung involvement. The volumes of lesions in the left and right lungs were 503.91 and 376.94 cm3 respectively. The acquired sum ratio for this volume involvements was 0.71 (or 71%).
See this image and copyright information in PMC

References

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