A 42-year-old woman was diagnosed with invasive ductal carcinoma of the right breast (T2-N1-MX), with estrogen, progesterone, and HER-2/neu receptors positive. Two of 10 axillary lymph nodes were positive. She was treated with lumpectomy, axillary node dissection, and adjuvant chemotherapy consisting of doxorubicin/cyclophosphamide. Therapy was discontinued after three cycles because she had developed local axillary and cutaneous recurrence. She was subsequently treated for 12 weeks with paclitaxel/trastuzumab on a clinical trial, underwent bilateral total mastectomies, and received 60 Gy of radiation to her right chest wall/axilla. She was evaluated 6 weeks after completion of radiotherapy. On examination she had normal vital signs and negative physical examination. Laboratory evaluation revealed alkaline phosphatase of 262 U/L (normal, 50 to 136 U/L), AST and ALT of 72 U/L and 92 U/L, respectively (normal, 3 to 48 U/L and 30 to 65 U/L). These were normal 4 months earlier. Abdominal computed tomography scan revealed an abnormal “straight-border”1—attenuation of the liver along the trajectory of radiation beam used previously—representing radiation-induced liver disease (RILD; Fig 1A, arrows).