Longitudinal MR Imaging of Pulmonary Function in Patients Receiving Thoracic Radiation Treatment

Study Overview
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Brief Summary
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The purpose of this study is to determine whether magnetic resonance imaging (MRI) using inhaled hyper polarized xenon-129 (129Xe) gas, and conventional contrast can help visualize impaired lung function and detect changes over time in patients receiving treatment as well as those who don't. 129Xe is a special type of xenon gas and when inhaled during MRI may be able to show areas of abnormal thickening of parts of the lungs. These images combined with images taken with injected contrast agents or other special types of MRI such as conventional proton (1H) MRI may provide a better way to look at lung structure and function. The ultimate goal is to predict the degree of radiation-induced lung injury that will develop in a given patient for a given treatment plan. The investigators anticipate that these images will provide more specific information about lung disease than standard lung function tests. The use of 129Xe MRI is investigational. Investigational means that these tests have not yet been approved by the US Food and Drug Administration and are only available in research studies like this one. In addition, standard MRI with contrast is not typically done as standard of care for monitoring changes due to thoracic radiation therapy, therefore, its use in this study is also considered investigational. Healthy volunteers are being asked to participate in this study because to develop a database of functional images that are representative of healthy lungs.

Official Title
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Longitudinal MR Imaging of Pulmonary Function in Patients Receiving Thoracic Radiation Treatment

Conditions
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Radiation Injury

Intervention / Treatment
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* Drug: Hyperpolarized 129-Xenon gas
* Device: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for Patients: Patient scheduled to undergo thoracic RT at Duke University to a dose of at least 20 Gy Willing and able to give informed consent and adhere to visit/protocol schedules Exclusion Criteria for Patients: Subject is less than 18 years old MRI is contraindicated based on responses to MRI Screening questionnaire Subject is pregnant or lactating Respiratory illness of a bacterial or viral etiology within 30 days of MRI Subject has any form of known cardiac arrhythmia Subject does not fit into 129Xe vest coil used for MRI Subject cannot hold his/her breath for 15 seconds Subject deemed unlikely to be able to comply with instructions during imaging Medical or psychological conditions which, in the opinion of the investigator, might create undue risk to the subject or interfere with the subject's ability to comply with the protocol requirements Inclusion/Exclusion Criteria for Healthy Volunteers 1. Subject meets all criteria above but does not have a clinical diagnosis of respiratory disease.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Patients scheduled to undergo Radiation Therapy (RT)<br>Patients scheduled to undergo Radiation Therapy (RT) for lung cancer, or other malignancies such as breast cancer or lymphoma that involve significant irradiation of the thoracic cavity. | Drug: Hyperpolarized 129-Xenon gas<br>* Hyperpolarized xenon will be administered in multiple doses in volumes up to 25% of subject total lung capacity (TLC) followed by a breath hold of up to 15 seconds. Subsequent 129Xe doses will only be administered once the subject is ready to proceed.<br>* Other names: Hyperpolarized 129Xe;Device: MRI<br>* Conventional 1H MRI will be used to provide anatomical reference scans, as well as pulmonary perfusion.<br>|
| Active Comparator: Healthy volunteers<br> | Drug: Hyperpolarized 129-Xenon gas<br>* Hyperpolarized xenon will be administered in multiple doses in volumes up to 25% of subject total lung capacity (TLC) followed by a breath hold of up to 15 seconds. Subsequent 129Xe doses will only be administered once the subject is ready to proceed.<br>* Other names: Hyperpolarized 129Xe;Device: MRI<br>* Conventional 1H MRI will be used to provide anatomical reference scans, as well as pulmonary perfusion.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pulmonary Function, as Measured by Ventilation Defect Percentage (VDP) | Ventilation is defined as the regional 129Xe airspace signal divided by the top 1% of 129Xe airspace signal (representing open-airway ventilation). A Ventilation Defect is defined as any region of lung where the Ventilation signal is more than 2 standard deviations below the mean Ventilation signal of healthy volunteer subjects' lungs. Ventilation Defect Percentage, or VDP, is defined as the volume of a subject's Ventilation Defects divided by the volume of the subject's lung, multiplied by 100%. | Baseline, following radiation treatment (up to 3 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Gas Exchange Defect Percentage (EDP) Following RT (Radiation Treatment) | Gas exchange is defined as the ratio of the signal from 129Xe transiently bonding with hemoglobin in the pulmonary capillaries to the local 129Xe airspace signal. In other publications, the investigators have referred to this as RBC (red blood cell) transfer. A Gas Exchange Defect is defined as any region of lung where the Gas Exchange signal is more than 2 standard deviations below the mean Gas Exchange signal of healthy volunteer subjects' lungs. Gas Exchange Defect Percentage, or EDP, is defined as the volume of a subject's Gas Exchange Defects divided by the volume of the subject's lung, multiplied by 100%. | Baseline, following RT (up to 3 months) | 
| RBC (Red Blood Cell) to Barrier Ratio Following RT | RBC:barrier ratio is defined as the ratio of the whole lung signal from 129Xe transiently bonding with hemoglobin in the pulmonary capillaries to the whole lung signal from 129Xe in the alveolar barrier tissue. | Baseline, following RT (up to 3 months) | 
| Change in High Barrier Uptake Percentage (HBUP) Following RT | Barrier Uptake is defined as the ratio of the regional signal from 129Xe dissolved in the interstitial space within the alveolar walls to the regional signal from 129Xe in the adjacent airspaces. High Barrier Uptake is defined as any region of lung where the Barrier Uptake signal is more than 2 standard deviations above the mean Barrier Uptake signal of healthy volunteer subjects' lungs. High Barrier Uptake Percentage, or HBUP, is defined as the volume of a subject's lung exhibiting High Barrier Uptake divided by the total volume of the subject's lung, multiplied by 100%. | Baseline, following RT (up to 3 months) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Radiation induced lung injury, Xenon gas, hyperpolarized