My rule for lung SBRT has been to minimize the use of contrast given the patient population we are treating (elderly, frail, and a desire to minimize kidney stressors), and the fact that we are following lung parenchymal lesions which are generally well visualized without contrast. I also have never...

If the patient received SBRT or chemo/RT within 5 years, my preference is still chest CT with IV contrast, if the patient doesn’t have a significant allergy for IV contrast. Chest CT with IV contrast has much better image quality to evaluate lymph node status. However, if the patient has no ev...