The document proposes a trial investigating the hypothesis that low dose radiation may reduce cytokine release severity and mortality in symptomatic COVID-19 patients. It suggests that ideal candidates are confirmed COVID-19 patients prior to significant cytokine release, using thoracic imaging for early detection. The study design involves randomization to various radiation doses and targets the whole thorax, with early endpoints including the need for ventilation and mortality stratified by risk factors.

1. Low Dose Radiation for Mild to
Moderately Symptomatic
COVID-19
Conceptual for trial, do not try
Matt Katz, MD

2. Hypothesis
• Low dose radiation can interfere with
inflammatory cascade to reduce severity of
cytokine release
• Treatment with low dose radiation can lessen
mortality for symptomatic patients with
COVID-19

3. Who is the ideal cohort?
• ? Confirmed COVID+ patients before cytokine
release occurs
• Delays in diagnosis may preclude molecular
test so can consider thoracic imaging

4. Use of chest CT
• CT imaging may detect before positive
molecular testing and may identify higher risk
patients
– Li et al, Korean J Radiol
• CT findings correlate with mortality in COVID-
19
– Yuan M et al PLoS ONE

5. Design?
Confirmed
COVID19 by history and CT
Randomize to
0 cGy 30 cGy
x 5
60 cGy
x 5
60 cGy
x 10
Radiation target volume = whole thorax including heart

6. Early Endpoints (4 weeks)
• Requiring ventilation
• Mortality

7. Stratify by ?
• Age
• Diabetes
• Cardiac disease
• Neutrophil count