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Functional Imaging in Radiotherapy in the Netherlands: Availability and Impact on Clinical Practice.

W V Vogel1, M G E H Lam2, F A Pameijer2

  • 1Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Nuclear Medicine, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|October 4, 2016
PubMed
Summary

Functional imaging with PET/CT and mpMR is standard of care in Dutch radiotherapy, aiding treatment decisions. Further standardization is needed for consistent interpretation in specific clinical scenarios.

Keywords:
Care evaluationMRPET/CTfunctional imagingpatterns of careradiotherapy

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Area of Science:

  • Radiotherapy
  • Medical Imaging
  • Oncology

Background:

  • Functional imaging, including PET/CT and multiparametric MRI (mpMR), is increasingly used in radiotherapy.
  • Limited evidence and experience with these techniques can lead to variations in clinical practice.
  • This study evaluated the current patterns of care for functional imaging in radiotherapy in the Netherlands.

Purpose of the Study:

  • To assess the availability and utilization of functional imaging in Dutch radiotherapy centers.
  • To determine the impact of functional imaging on clinical decision-making across various cancer types.
  • To identify challenges and areas for improvement in the application of functional imaging for radiotherapy.

Main Methods:

  • A care evaluation study was conducted across 18 radiotherapy centers in the Netherlands.
  • Availability of PET/CT and mpMR for radiotherapy was assessed, defining standard of care features.
  • Clinical impact was evaluated using case questionnaires for lung, head/neck, breast, and prostate cancers, analyzing decision-making variability.

Main Results:

  • PET/CT is available in 94% of centers, and mpMR in 100%, with significant availability in treatment positions.
  • Functional imaging demonstrated a high clinical impact (median 4.3/6) and good observer agreement (IQR 1.1/6) overall.
  • Issues like positional discrepancies and diagnostic variability were noted, impacting consistent interpretation.

Conclusions:

  • Access to PET/CT and mpMR, coupled with collaborative technologists and multimodal delineation, represents the standard of care in the Netherlands.
  • While functional imaging is widely adopted, standardization of image interpretation is recommended for specific clinical situations.
  • Further efforts are needed to optimize the use of functional imaging for enhanced radiotherapy planning and delivery.