PET/CT imaging for target volume delineation in curative intent radiotherapy of non-small cell lung cancer: IAEA consensus report 2014

Konert, Tom; Vogel, Wouter V.; MacManus, Michael; Nestle, Ursula; Belderbos, J.; Grégoire, Vincent; Thorwarth, Daniela; Fidarova, Elena; Páez, Diana; Chiti, Arturo; Hanna, G.G.

doi:10.1016/j.radonc.2015.03.014

Cited by 126 publications

(102 citation statements)

References 62 publications

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“…The methods range from simple to complex methods. 1,3,4 The segmentation methods include but are not limited to constant and adaptive threshold methods, [5][6][7][8][9] region growing methods, [10][11][12] gradient-based methods, [13][14][15] fuzzy models, [16][17][18] and Gaussian mixture modeling. 10,19 All these methods offer different compromises in terms of versatility and performance and compare well against manual segmentations by clinicians or the pathological measurements with varying rates of success.…”

Section: Introductionmentioning

confidence: 99%

Hybrid positron emission tomography segmentation of heterogeneous lung tumors using 3D Slicer: improved GrowCut algorithm with threshold initialization

et al. 2017

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Abstract. This paper presents an improved GrowCut (IGC), a positron emission tomography-based segmentation algorithm, and tests its clinical applicability. Contrary to the traditional method that requires the user to provide the initial seeds, the IGC algorithm starts with a threshold-based estimate of the tumor and a threedimensional morphologically grown shell around the tumor as the foreground and background seeds, respectively. The repeatability of IGC from the same observer at multiple time points was compared with the traditional GrowCut algorithm. The algorithm was tested in 11 nonsmall cell lung cancer lesions and validated against the clinician-defined manual contour and compared against the clinically used 25% of the maximum standardized uptake value [SUV-(max)], 40% SUV max , and adaptive threshold methods. The time to edit IGC-defined functional volume to arrive at the gross tumor volume (GTV) was compared with that of manual contouring. The repeatability of the IGC algorithm was very high compared with the traditional GrowCut (p ¼ 0.003) and demonstrated higher agreement with the manual contour with respect to threshold-based methods. Compared with manual contouring, editing the IGC achieved the GTV in significantly less time (p ¼ 0.11). The IGC algorithm offers a highly repeatable functional volume and serves as an effective initial guess that can well minimize the time spent on labor-intensive manual contouring.

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Section: Introductionmentioning

confidence: 99%

Hybrid positron emission tomography segmentation of heterogeneous lung tumors using 3D Slicer: improved GrowCut algorithm with threshold initialization

et al. 2017

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“…For visual assessment, standardized window/ level settings are strongly suggested, since even marginal alterations can cause significant differences in the apparent tumor extent on PET images and thus in the resulting TV. The IAEA publication provides guidance on the use and role of PET-CT imaging for radiotherapy treatment planning in NSCLC (35). RTOG1106, a multicenter study requires PET metabolic tumor volumes to form the PTV at the baseline, using a combined method of autosegmentation thresholding at 1.5 ratio of mediastinum blood pool followed knowledge based manual editing (43).…”

Section: Imaging For Tv Delineation For Radiotherapymentioning

confidence: 99%

Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization

MacManus

Everitt

Schimek-Jasch

et al. 2017

Transl. Lung Cancer Res.

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This article reviews key imaging modalities for lung cancer patients treated with radiation therapy (RT) and considers their actual or potential contributions to critical decision-making. An international group of researchers with expertise in imaging in lung cancer patients treated with RT considered the relevant literature on modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). These perspectives were coordinated to summarize the current status of imaging in lung cancer and flag developments with future implications.Although there are no useful randomized trials of different imaging modalities in lung cancer, multiple prospective studies indicate that management decisions are frequently impacted by the use of complementary imaging modalities, leading both to more appropriate treatments and better outcomes. This is especially true of 18 F-fluoro-deoxyglucose (FDG)-PET/CT which is widely accepted to be the standard imaging modality for staging of lung cancer patients, for selection for potentially curative RT and for treatment planning. PET is also more accurate than CT for predicting survival after RT. PET imaging during RT is also correlated with survival and makes response-adapted therapies possible. PET tracers other than FDG have potential for imaging important biological process in tumors, including hypoxia and proliferation. MRI has superior accuracy in soft tissue imaging and the MRI Linac is a rapidly developing technology with great potential for online monitoring and modification of treatment. The role of imaging in RT-treated lung cancer patients is evolving rapidly and will allow increasing personalization of therapy according to the biology of both the tumor and dose limiting normal tissues.

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“…The success of high-precision radiotherapy is determined not only by an adequate control of daily patient positioning during the treatment course (safeguarded by ‘image guided radiotherapy’ (IGRT)) but, first and foremost, by an accurate target volume definition. As FDG-PET fulfills the demand for high diagnostic accuracy in the staging of NSCLC, it can enhance the quality of treatment planning in NSCLC significantly [5–9]. However, FDG-PET based treatment planning in NSCLC involves some unresolved issues.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Diffusion-Weighted MRI on the Definition of Gross Tumor Volume in Radiotherapy of Non-Small-Cell Lung Cancer

et al. 2016

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ObjectiveThe study was designed to evaluate diffusion-weighted magnetic resonance imaging (DWI) vs. PET-CT of the thorax in the determination of gross tumor volume (GTV) in radiotherapy planning of non-small-cell lung cancer (NSCLC).Materials and MethodsEligible patients with NSCLC who were supposed to receive definitive radio(chemo)therapy were prospectively recruited. For MRI, a respiratory gated T2-weighted sequence in axial orientation and non-gated DWI (b = 0, 800, 1,400 and apparent diffusion coefficient map [ADC]) were acquired on a 1.5 Tesla scanner. Primary tumors were delineated on FDG-PET/CT (stGTV) and DWI images (dwGTV). The definition of stGTV was based on the CT and visually adapted to the FDG-PET component if indicated (e.g., in atelectasis). For DWI, dwGTV was visually determined and adjusted for anatomical plausibility on T2w sequences. Beside a statistical comparison of stGTV and dwGTB, spatial agreement was determined with the “Hausdorff-Distance” (HD) and the “Dice Similarity Coefficient” (DSC).ResultsFifteen patients (one patient with two synchronous NSCLC) were evaluated. For 16 primary tumors with UICC stages I (n = 4), II (n = 3), IIIA (n = 2) and IIIB (n = 7) mean values for dwGTV were significantly larger than those of stGTV (76.6 ± 84.5 ml vs. 66.6 ± 75.2 ml, p<0.01). The correlation of stGTV and dwGTV was highly significant (r = 0.995, p<0.001). Yet, some considerable volume deviations between these two methods were observed (median 27.5%, range 0.4–52.1%). An acceptable agreement between dwGTV and stGTV regarding the spatial extent of primary tumors was found (average HD: 2.25 ± 0.7 mm; DC 0.68 ± 0.09).ConclusionThe overall level of agreement between PET-CT and MRI based GTV definition is acceptable. Tumor volumes may differ considerably in single cases. DWI-derived GTVs are significantly, yet modestly, larger than their PET-CT based counterparts. Prospective studies to assess the safety and efficacy of DWI-based radiotherapy planning in NSCLC are warranted.

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PET/CT imaging for target volume delineation in curative intent radiotherapy of non-small cell lung cancer: IAEA consensus report 2014

Cited by 126 publications

References 62 publications

Hybrid positron emission tomography segmentation of heterogeneous lung tumors using 3D Slicer: improved GrowCut algorithm with threshold initialization

Hybrid positron emission tomography segmentation of heterogeneous lung tumors using 3D Slicer: improved GrowCut algorithm with threshold initialization

Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization

The Impact of Diffusion-Weighted MRI on the Definition of Gross Tumor Volume in Radiotherapy of Non-Small-Cell Lung Cancer

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