Effectiveness of Cone Beam Computed Tomography Imaging During Radiation Therapy for the Detection of Initial Coronavirus Lung Disease 2019

In this unique historic period afflicted by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, radiation therapy treatments cannot be delayed or suspended. We report the case of a 73-year-old woman with recently diagnosed extensive-stage small cell lung cancer with metastatic liver and bone lesions. A SARS-CoV-2 test was performed upon hospital admission and was negative. After 5 days she underwent radiation therapy on T6 and T11 with single fractions of 8 Gy each. Before treatment a cone beam computed tomography (CBCT) scan was performed to check the setup of the patient. Some suspected lung areas of ground glass opacities (GGOs) were clearly visible in the CBCT without any counterpart in the previous computed tomography (CT) simulation scan 3 days before. A new high-quality chest CT scan confirmed the previously suspected GGOs. The exam revealed multiple bilateral areas of subpleural GGOs, which are the primary findings on CT scan in the early phases of coronavirus disease 2019 (COVID-19) lung infection, in addition to pleural effusions, a finding that may occur as a complication of COVID-19. The patient then urgently repeated the SARS-CoV-2 test, which was positive and confirmed the infection. In conclusion, daily CBCT can be effective for early detection of COVID-19 lung disease in asymptomatic or mildly symptomatic patients.