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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
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Generating lung tumor internal target volumes from 4D-PET maximum intensity projections.

J M Lamb1, C Robinson, J Bradley

  • 1Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA. jlamb@mednet.ucla.edu

Medical Physics
|October 14, 2011
PubMed
Summary

Respiratory-correlated Positron Emission Tomography (PET) improves lung tumor imaging for radiotherapy. Gated PET maximum intensity projection (MIP) offers a time-efficient method to incorporate this data into treatment planning, enhancing accuracy.

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Area of Science:

  • Nuclear Medicine
  • Radiotherapy Planning
  • Medical Imaging

Background:

  • Positron emission tomography (PET) for lung tumors is blurred by breathing motion.
  • Respiratory-correlated PET visualizes functional uptake but has limited use in radiotherapy planning.

Purpose of the Study:

  • To propose and evaluate a gated PET maximum intensity projection (MIP) technique.
  • To quantitatively and efficiently incorporate respiratory-correlated PET into radiotherapy planning.

Main Methods:

  • Acquired 4D-CT and respiratory-gated FDG-PET for four small lung tumors.
  • Generated internal target volumes (ITVs) from PET-MIP, ungated PET, and 4D-CT.
  • Compared volumetric overlap and relative volumes of ITVs using various segmentation thresholds.

Main Results:

  • PET-MIP ITVs showed significantly better overlap and volume agreement with CT-MIP ITVs compared to ungated PET ITVs.
  • Mean normalized overlap for PET-MIP was 0.68 ± 0.07 versus 0.47 ± 0.12 for ungated PET.
  • Mean relative volume for PET-MIP was 1.07 ± 0.42 versus 0.69 ± 0.56 for ungated PET.

Conclusions:

  • Gated PET-MIP images provide a better match to CT-MIP images for small, CT-visible lung tumors.
  • PET-MIP is an efficient method for radiation oncologists to integrate 4D-PET data into lung tumor contouring.
  • This technique requires minimal implementation effort in treatment planning software.