{
  "abstract": "Introduction Patient harm may be reduced by directing radiation dose away from well-functioning lung tissue. Radiotherapy planning requires a balance between ensuring adequate dose to the tumour whilst minimising dose exposure of susceptible normal tissues. Radiation induced lung injury, a consequence of radiotherapy, occurs in 5–50% of non-small cell lung cancer (NSCLC) patients, causing serious sequelae. 1 Regional lung function for radiotherapy planning has been explored using CT/PET, 4DCT and 129Xe-MRI.219F MRI of inhaled perfluoropropane (PFP) is an emerging method for quantitative imaging of ventilation that does not use ionising radiation and has a lower barrier to entry than hyperpolarized gas MRI. We report the first assessment of 19F-MRI to inform radiotherapy planning.Methods Multiple breath dynamic 19F-MRI of inhaled 79% PFP/21% oxygen gas mixture was performed in 12 NSCLC patients before radiotherapy. Regional Lung Clearance Index (RLCI; number of breaths required to turnover 97.5% of gas in each image voxel) was calculated across lung volume to give a quantitative regional ventilation map. Lung was stratified into ‘well’, ‘moderately’ and ‘poorly’ ventilated regions.‘Functional avoidance plans’ were created, using the stratified RLCI mapped in Raystation to participant radiotherapy planning CT scans. Radiation doses delivered to lung were measured in both standard and functional avoidance plans.Results 19F MRI scans were acquired from 12 NSCLC patients and RLCI maps created. 6 participants have had standard and avoidance plans created to date, showing a mean change of -14.48% (range -33.1 to +10.1) in volume of well-ventilated lung within the tissue receiving 20 Gy or more radiation.Conclusions Maps of lung ventilation from dynamic 19F MRI can stratify lung tissue according to ventilation and be used in treatment planning of NSCLC patients. This has potential for improved sparing of well-ventilated lung tissue in cancer patients. This tool can advance our understanding of lung ventilation patterns in patients, with the aim of improving clinical outcomes such as incidence, severity, and persistence of radiation induced lung injury.Reference Bucknell NW, et al. Functional lung imaging in radiation therapy for lung cancer: a systematic review and meta-analysis. Radiotherapy and Oncology. 2018(129) 2.",
  "authors": [
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK"
      ],
      "name": "CW Holland"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK",
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "RA Pearson"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "P Atherton"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK"
      ],
      "name": "D Harrison"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "A Hassani"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK",
        "Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK"
      ],
      "name": "H McCallum"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "FE McDonald"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK"
      ],
      "name": "MA Neal"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "J Phillips"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "R Pickles"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "E Smith"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "A Stamp"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "H Turnbull"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "S Warren"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "N Willis"
    },
    {
      "affiliations": [
        "Northern Centre for Cancer Care, Newcastle-upon-Tyne NHS Trust, Newcastle-upon-Tyne, UK"
      ],
      "name": "M Zarroug"
    },
    {
      "affiliations": [
        "Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK"
      ],
      "name": "P Thelwall"
    }
  ],
  "title": "P175 Using dynamic 19F MRI of lung ventilation properties to prioritise functional lung in radiotherapy treatment planning for non-small cell lung cancer",
  "uid": "d09ab7fe-80df-5da9-9825-34591b44e68b"
}