Document Type : Review Article
Authors
- Farshid Gheisari 1, 2
- Mehdi Shariat 3
- Mohammad Kamali 4
- Mohammad Reza Daneshmandi 4
- Mohammad Atefi 1
- Amirsalar Motamedi 4
1 Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Nuclear Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
The COVID-19 pandemic has underscored the need for advanced diagnostic and therapeutic modalities in the management of this infection. Ionizing radiation has long been leveraged in medicine for essential purposes, including the diagnosis and treatment of malignancies and infections. Nuclear medicine exploits these radiations in imaging techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT), which provide valuable insights for diagnosis, follow-up, and understanding the pathogenesis of COVID-19 infection. Furthermore, computed tomography (CT), which utilizes X-ray radiation, plays an important role in diagnosing COVID-19 respiratory infection. Targeted radionuclide therapies—such as those employing Auger electron emitters and alpha particles—have been investigated as potential therapeutic tools against SARS-CoV-2. Additionally, gamma and X-rays are deployed in the sterilization of medical equipment and the production of SARS-CoV-2 vaccines. This narrative review aimed to briefly examine the applications of ionizing radiations in the management of COVID-19 infection, with an emphasis on recent developments. While further research is required for clinical implementation, ionizing radiation offers considerable current and potential applications in the battle against COVID-19.
Keywords
- Talapko J, Talapko D, Katalinić D, Kotris I, Erić I, Belić D, et al. Health effects of ionizing radiation on the human body. Medicina (Kaunas). 2024;60(4):653.
- Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: what we know. Int J Infect Dis. 2020;94:44-8.
- McCabe R, Schmit N, Christen P, D’Aeth JC, Løchen A, Rizmie D, et al. Adapting hospital capacity to meet changing demands during the COVID-19 pandemic. BMC Med. 2020;18(1):329.
- Griffin MT, Werner TJ, Alavi A, Revheim ME. The value of FDG-PET/CT imaging in the assessment, monitoring, and management of COVID-19. Eur Phys J Plus. 2023;138(3):283.
- Tipre DN, Cidon M, Moats RA. Imaging pulmonary blood vessels and ventilation-perfusion mismatch in COVID-19. Mol Imaging Biol. 2022;24(4):526-36.
- Pallares RM, Abergel RJ. Diagnostic, prognostic, and therapeutic use of radiopharmaceuticals in the context of SARS-CoV-2. ACS Pharmacol Transl Sci. 2021;4(1):1-7.
- Chalkia M, Arkoudis NA, Maragkoudakis E, Rallis S, Tremi I, Georgakilas AG, et al. The role of ionizing radiation for diagnosis and treatment against COVID-19: evidence and considerations. Cells. 2022;11(3):432.
- Neumaier F, Zlatopolskiy BD, Neumaier B. Nuclear medicine in times of COVID-19: how radiopharmaceuticals could help to fight the current and future pandemics. Pharmaceutics. 2020;12(12):1284.
- Eibschutz LS, Rabiee B, Asadollahi S, Gupta A, Assadi M, Alavi A, et al. FDG-PET/CT of COVID-19 and other lung infections. Semin Nucl Med. 2022;52(1):61-70.
- Lee Y, Park Y, Nam H, Lee JW, Yu SW. Translocator protein (TSPO): the new story of the old protein in neuroinflammation. BMB Rep. 2020;53(1):20-7.
- Lee H, Park J, Im HJ, Na KJ, Choi H. Discovery of potential imaging and therapeutic targets for severe inflammation in COVID-19 patients. Sci Rep. 2021;11(1):14151.
- Wischmann J, Bartos LM, Brendel M, Albert NL, Forbrig R, Straube A, et al. Translocator protein (TSPO)-PET as diagnostic and monitoring tool in COVID-19 related MRI-negative brainstem encephalitis: a case report. J Neurol. 2023;270(6):2853-6.
- Jin C, Luo X, Qian S, Zhang K, Gao Y, Zhou R, et al. Positron emission tomography in the COVID-19 pandemic era. Eur J Nucl Med Mol Imaging. 2021;48(12):3903-17.
- Topuz OV, Aksu A, Yilmaz B. Is there any change in the muscle uptake pattern of FDG during or after COVID-19 infection in oncological FDG PET-CT patients? J Nucl Med. 2021;62(Suppl 1):1234.
- Minamimoto R. Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: a review of available literature data. Front Med (Lausanne). 2022;9:1052921.
- Mortensen J, Gutte H. SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging. 2014;41(1):81-90.
- Bhatia KD, Ambati C, Dhaliwal R, Paschkewitz R, Hsu E, Ho B, et al. SPECT-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: pre-existing lung disease should not be a contraindication. J Med Imaging Radiat Oncol. 2016;60(4):492-7.
- Dhawan RT, Gopalan D, Howard L, Vicente A, Park M, Manalan K, et al. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. Lancet Respir Med. 2021;9(1):107-16.
- Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K, et al. SPECT/CT. J Nucl Med. 2008;49(8):1305-19.
- Meyer PT, Hellwig S, Blazhenets G, Hosp JA. Molecular imaging findings on acute and long-term effects of COVID-19 on the brain: a systematic review. J Nucl Med. 2022;63(7):971-80.
- Idrissou MB, Pichard A, Tee B, Kibedi T, Poty S, Pouget JP. Targeted radionuclide therapy using Auger electron emitters: the quest for the right vector and the right radionuclide. Pharmaceutics. 2021;13(7):1022.
- Thomas S, Smatti MK, Ouhtit A, Cyprian FS, Almaslamani MA, Thani AA, et al. Antibody-dependent enhancement (ADE) and the role of complement system in disease pathogenesis. Mol Immunol. 2022;152:172-82.
- Guerra Liberal FD, O’Sullivan JM, McMahon SJ, Prise KM. Targeted alpha therapy: current clinical applications. Cancer Biother Radiopharm. 2020;35(6):404-17.
- Pallares RM, Flick M, Shield KM, Bailey TA, Velappan N, Lillo AM, et al. Development of an actinium-225 radioimmunoconjugate for targeted alpha therapy against SARS-CoV-2. New J Chem. 2022;46(33):15795-8.
- Rafiepour P, Sina S, Mortazavi SMJ. Inactivation of SARS-CoV-2 by charged particles for future vaccine production applications: a Monte Carlo study. Radiat Phys Chem. 2022;198:110265.
- Liu F, Zhong Z, Liu B, Jiang T, Zhou H, Li G, et al. SARS-CoV-2 inactivation simulation using 14 MeV neutron irradiation. Life (Basel). 2021;11(12):1345.
- Sandle T. Electron beam processing. In: Sandle T, editor. Sterility, sterilisation and sterility assurance for pharmaceuticals. Cambridge: Woodhead Publishing; 2013. p. 69-81.
- Wang Z, Liang Z, Wei R, Wang H, Cheng F, Liu Y, et al. Quantitative determination of the electron beam radiation dose for SARS-CoV-2 inactivation to decontaminate frozen food packaging. Virol Sin. 2022;37(6):823-30.
- Marion JB. Radiation—effects and uses. In: Marion JB, editor. Physics in the modern world. 2nd ed. New York: Academic Press; 1981. p. 603-31.
- Feldmann F, Shupert WL, Haddock E, Twardoski B, Feldmann H. Gamma irradiation as an effective method for inactivation of emerging viral pathogens. Am J Trop Med Hyg. 2019;100(5):1275-7.
- Zhang S, Wang X, Gao X, Chen X, Li L, Li G, et al. Radiopharmaceuticals and their applications in medicine. Signal Transduct Target Ther. 2025;10(1):1.
- Afrough B, Eakins J, Durley-White S, Dowall S, Findlay-Wilson S, Graham V, et al. X-ray inactivation of RNA viruses without loss of biological characteristics. Sci Rep. 2020;10(1):21431.
- Malinowski M. Using X-ray technology to sterilize medical devices. Am J Biomed Sci Res. 2021;12(3):272-6.
- Mortazavi SMJ, Kefayat A, Cai J. Point/counterpoint. Low-dose radiation as a treatment for COVID-19 pneumonia: a threat or real opportunity? Med Phys. 2020;47(9):3773-6.
- Mortazavi SAR, Jafarzadeh A, Ghadimi-Moghadam A, Mortazavi SMJ, Haghani M, Ghadimi-Moghadam A, et al. Breakthrough infection and death after COVID-19 vaccination: a physics perspective. J Biomed Phys Eng. 2023;13(4):301-6.
- Mortazavi SMJ, Shams SF, Mohammadi S, Mortazavi SAR, Sihver L. Low-dose radiation therapy for COVID-19: a systematic review. Radiation. 2021;1(3):234-49.
- Reza Mortazavi A, Ghadimi-Moghadam A, Jafarzadeh A, Welsh JS, Mashhadi MHP, Haghani M, et al. Co-infection of COVID-19, influenza and RSV: how non-pharmaceutical therapeutic approaches such as low dose radiation therapy can be a game changing strategy. Dis Res. 2024;4(2):108-12.
- Bhatia SS, Pillai SD. Ionizing radiation technologies for vaccine development—a mini review. Front Immunol. 2022;13:845514.
- Schulze K, Weber U, Schuy C, Durante M, Guzmán CA. Influenza virus inactivated by heavy ion beam irradiation stimulates antigen-specific immune responses. Pharmaceutics. 2024;16(4):512.