4D PET-CT guided radiation therapy

Geets, Xavier

doi:10.5334/jbr-btr.236

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…Our previously published criteria were adapted to investigate geographic miss in 3D vs 4D defined target volumes [ 16 ]. 4D-PET/CT has been shown to account well for tumour motion it was considered the reference for which the 3D-PET/CT was compared against [ 17 - 19 ]. The types of geographic miss were defined as follows and are outlined in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Geographic miss of lung tumours due to respiratory motion: a comparison of 3D vs 4D PET/CT defined target volumes

et al. 2014

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BackgroundPET/CT scans acquired in the radiotherapy treatment position are typically performed without compensating for respiratory motion. The purpose of this study was to investigate geographic miss of lung tumours due to respiratory motion for target volumes defined on a standard 3D-PET/CT.Methods29 patients staged for pulmonary malignancy who completed both a 3D-PET/CT and 4D-PET/CT were included. A 3D-Gross Tumour Volume (GTV) was defined on the standard whole body PET/CT scan. Subsequently a 4D-GTV was defined on a 4D-PET/CT MIP. A 5 mm, 10 mm, 15 mm symmetrical and 15×10 mm asymmetrical Planning Target Volume (PTV) was created by expanding the 3D-GTV and 4D-GTV’s. A 3D conformal plan was generated and calculated to cover the 3D-PTV. The 3D plan was transferred to the 4D-PTV and analysed for geographic miss. Three types of miss were measured. Type 1: any part of the 4D-GTV outside the 3D-PTV. Type 2: any part of the 4D-PTV outside the 3D-PTV. Type 3: any part of the 4D-PTV receiving less than 95% of the prescribed dose. The lesion motion was measured to look at the association between lesion motion and geographic miss.ResultsWhen a standard 15 mm or asymmetrical PTV margin was used there were 1/29 (3%) Type 1 misses. This increased 7/29 (24%) for the 10 mm margin and 23/29 (79%) for a 5 mm margin. All patients for all margins had a Type 2 geographic miss. There was a Type 3 miss in 25 out of 29 cases in the 5, 10, and 15 mm PTV margin groups. The asymmetrical margin had one additional Type 3 miss. Pearson analysis showed a correlation (p < 0.01) between lesion motion and the severity of the different types of geographic miss.ConclusionWithout any form of motion suppression, the current standard of a 3D- PET/CT and 15 mm PTV margin employed for lung lesions has an increasing risk of significant geographic miss when tumour motion increases. Use of smaller asymmetric margins in the cranio-caudal direction does not comprise tumour coverage. Reducing PTV margins for volumes defined on 3D-PET/CT will greatly increase the chance and severity of a geometric miss due to respiratory motion. 4D-imaging reduces the risk of geographic miss across the population of tumour sizes and magnitude of motion investigated in the study.

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Section: Methodsmentioning

confidence: 99%

Geographic miss of lung tumours due to respiratory motion: a comparison of 3D vs 4D PET/CT defined target volumes

et al. 2014

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“…With improved precision of planning systems, use of SRS or SRT, and high dose hypofractionated regimens, the chances of small deviations leading to significant errors in treatment delivery are much higher, and the use of IGRT is far more critical in these situations. Integration of LINACs with MR-based soft tissue imaging and PET-based biological imaging may help even further improve targeting accuracy in the future [ 42 , 43 ]. However, it is mandatory to ensure proper training of staff and QA at all steps for optimum use of such technology and its integration into routine use.…”

Section: Clinical Applications: Current and Futurementioning

confidence: 99%

Image Guidance in Radiation Therapy: Techniques and Applications

Goyal

Kataria

2014

Radiology Research and Practice

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In modern day radiotherapy, the emphasis on reduction on volume exposed to high radiotherapy doses, improving treatment precision as well as reducing radiation-related normal tissue toxicity has increased, and thus there is greater importance given to accurate position verification and correction before delivering radiotherapy. At present, several techniques that accomplish these goals impeccably have been developed, though all of them have their limitations. There is no single method available that eliminates treatment-related uncertainties without considerably adding to the cost. However, delivering “high precision radiotherapy” without periodic image guidance would do more harm than treating large volumes to compensate for setup errors. In the present review, we discuss the concept of image guidance in radiotherapy, the current techniques available, and their expected benefits and pitfalls.

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“…With improved precision of planning systems, use of stereotactic radiosurgery or radiotherapy and high dose hypofractionated regimens, the chances of small deviations leading to significant errors in treatment delivery are much higher, and the use of IGRT is far more critical in these situations. Integration of LINACs with MR-based soft tissue imaging and PET-based biological imaging may help even further improve targeting accuracy in the future [38,39]. However, use of such technology and its integration into routine use would mandate that proper QA and training be put in place before undertaking such procedures.…”

Section: Clinical Applications -Current and Futurementioning

confidence: 99%

Image Guided Radiation Therapy

Kataria¹

2014

J Nucl Med Radiat Ther

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With increasing emphasis on reducing the volume of radiation therapy fields while maintaining or improving precision of treatment and reducing radiation-related normal tissue toxicity, treatment position verification and correction before delivering radiotherapy had gained major importance. A variety of techniques have been developed that can accomplish this goal with aplomb, albeit each with its own set of limitations. The best method that eliminates uncertainties in treatment without a huge cost remains to be defined, but it is clear that carrying out "high precision radiotherapy" without periodic image guidance is as accurate as shooting in a dark room. This review discusses the concept of image guidance in radiotherapy, various techniques available along with expected benefits and pitfalls of these systems.

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4D PET-CT guided radiation therapy

Cited by 4 publications

References 33 publications

Geographic miss of lung tumours due to respiratory motion: a comparison of 3D vs 4D PET/CT defined target volumes

Geographic miss of lung tumours due to respiratory motion: a comparison of 3D vs 4D PET/CT defined target volumes

Image Guidance in Radiation Therapy: Techniques and Applications

Image Guided Radiation Therapy

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