Thoracic cancer imaging with PET /CT in radiation oncology
Significance. Respiratory motion has been shown to cause artifacts in PET/CT imaging. This breathing artifact can have a significant impact on PET quantification and it can lead to large uncertainties when using PET for radiation therapy planning. We have demonstrated a promising solution to resolve the breathing artifact by acquiring respiration-averaged CT (ACT) for PET/CT. The purpose of this work was to optimize the ACT acquisition for clinical implementation and to evaluate the impact of ACT on PET/CT quantification. The hypothesis was that ACT is an effective method in removing the breathing artifact when compared to our current clinical protocol. Methods. Phase and cine approaches for acquiring ACT were investigated and the results of these two approaches were compared to the ACT generated from clinical 4DCT data sets (abbreviated as ACT10phs ). In the phase approach, ACT was generated based on combinations of selected respiratory phases; in the cine approach, ACT was generated based on cine images acquired over a fixed cine duration. The phase combination and cine duration that best approximated the ACT10phs were determined to be the optimized scanning parameters. 216 thoracic PET/CT patients were scanned with both current clinical and the ACT protocols. The effects of ACT on PET/CT quantification were assessed by comparing clinical PET/CT and ACT PET/CT using 3 metrics: PET/CT image alignment, maximum standardized uptake value (SUVmax), and threshold segmented gross tumor volume (GTV). Results. ACT10phs can be best approximated to within 2% of SUV variation by phase averaging based on 4 representative phases, and to within 3% by cine image averaging based on >3s of cine duration. We implemented the cine approach on the PET/CT scanners and acquired 216 patient data sets. 68% of patients had breathing artifacts in their clinical PET/CT and the artifacts were removed/reduced in all corresponding ACT PET/CT. PET/CT quantification for lesions <50 >cm3 and located below the dome of the diaphragm was affected the most by the artifact. Conclusions. We have shown that ACT is an effective method for minimizing respiration artifact in PET/CT. The removal of the artifact significantly changed the SUVmax in 10% of the patients and substantially affected the segmented GTV.
Chi, Pai-Chun Melinda, "Thoracic cancer imaging with PET /CT in radiation oncology" (2007). Texas Medical Center Dissertations (via ProQuest). AAI3287361.