Advances in noninvasive imaging for detecting radiation-induced lung injury (RILI)

Purpose: Dr. Richard Hill performed pioneering work in the field of radiation-induced normal tissue injury to the lung including noninvasive imaging studies aimed at identifying imaging biomarkers of radiation-induced lung injury (RILI). RILI is a life-threatening toxicity of radiation exposure relevant to both cancer patients undergoing thoracic radiation therapy (RT) and victims of accidental radiation exposure. The ability to detect RILI noninvasively has the potential to guide treatment planning for RT and, in the case of victims of acute radiation exposures, inform the decision to start mitigative therapies. As part of this special issue of IJRB honoring Dr. Hill's many contributions to the field of radiation biology, this article reviews current advances in noninvasive imaging of RILI including computed tomography (CT), magnetic resonance (MR), hyperpolarized MR, nuclear medicine (PET and SPECT), and optical imaging with near-infrared (NIR) probes. Conclusion: The imaging modalities reviewed have potential to not only provide early identification of RILI but may also provide mechanistic insights into the progression of RILI via noninvasive detection of characteristic RILI mechanisms including: inflammation, vascular damage, cell death, oxidative stress, and fibrosis.