Purpose: Positron emission tomography (PET) of lung tumors suffers from breathing-motion induced blurring. Respiratory-correlated PET ameliorates motion blurring and enables visualization of lung tumor functional uptake throughout the breathing cycle but has achieved limited clinical use in radiotherapy planning. In this work, the authors propose a process for generating a gated PET maximum intensity projection (MIP), a breathing-phase projection of the 4D image set comprising gated PET images, as a technique to quantitatively and efficiently incorporate respiratory-correlated PET information into radiotherapy treatment planning.Methods: 4D-CT and respiratory-gated PET using 18Ffluorodeoxyglucose (FDG) were acquired of three patients with a total of four small (4-18 cc), clearly defined lower-lobe lung tumors. Internal target volumes (ITVs) for the lung tumors were generated by threshold-based segmentation of PET-MIP images and ungated PET images (ITVPET-MIP and ITV3D-PET, respectively), and by manual contouring of CT-MIP and end-exhale and end-inhale phases of 4D-CT (ITVCT-MIP) by a radiation oncologist. Because of the sensitivity of tumor segmentation to threshold value, several different thresholds were tested for ITV generation, including 40, 30, and 20 of maximum standardized uptake value (SUVmax) for FDG as well as absolute SUV thresholds of 2.5 and 3.0. The normalized overlap and relative volumes of ITVPET-MIP and ITV3D-PET with respect to ITVCT-MIP were compared. The images were also visually compared. ITVCT-MIP was considered a gold standard for these tumors with CT-visible morphology.Results: The mean and standard deviation normalized overlap and relative volumes between ITVPET-MIP and ITV CT-MIP were 0.68 ± 0.07 and 1.07 ± 0.42, respectively, averaged over all four tumors and all five threshold values. The mean and standard deviation normalized overlap and relative volumes of ITV 3D-PET and ITVCT-MIP were 0.47 ± 0.12 and 0.69 ± 0.56, respectively.Conclusions: PET-MIP images better match CT-MIP images for this sample of four small CT-visible tumors as compared to ungated PET images, based on the metrics of volumetric overlap and relative volumes as well as visual interpretation. The PET-MIP is a way to incorporate 4D-PET imaging into the process of lung tumor contouring that is time-efficient for the radiation oncologist and involves minimal effort to implement in treatment planning software, because it requires only a single PET image beyond contouring on CT alone.
- lung cancer
- radiotherapy treatment planning