Intensity modulated radiotherapy of non-small-cell lung cancer incorporating SPECT ventilation imaging

Abstract

In conclusion, it is feasible to use SPECT ventilation scans to optimize IMRT beam direction and, subsequently, to reduce dose to ventilated lung when overlap of the PTV and the ventilated lung is minimal and that the PTV is not surrounded by the ventilated lung. The potential benefit of ventilation SPECT scanning can be determined by preplanning assessment of overlap volumes and the AAMvLD.

High-resolution pulmonary ventilation and perfusion PET/CT allows for functionally adapted intensity modulated radiotherapy in lung cancer

“…Additionally, no benefit was seen despite the investigation of two different methodologies to generate clinically equivalent functional volumes to the perfusion dataset -a volume generated using a similar SUVmax threshold and a second volume generated to approximate the physical volume of the perfused lung. Qualitatively, it was apparent that the VLung volume generated using the 50th centile SUV threshold (as previously reported by Munawar et al [11]) resulted in numerous small islands of volume throughout the lung rather than one contiguous volume, which limited the capacity for functional adaptation of radiotherapy.…”

“…A highly perfused lung volume (HPLung) and highly ventilated lung volume (HVLung) were delineated using a visually adapted 70th centile SUV threshold method, as recently described by our group [15,16] and others [17]. It was apparent that HVLung was considerably smaller than HPLung, so a ventilated lung volume (VLung) was created to approximate the HPLung volume using the 50th centile SUV threshold, a methodology previously reported by Munawar et al [11]. Any clumping of Galligas was excluded from the volume using the method described by Kipritidis et al [18], by which an upper threshold was set that removed voxels >4 standard deviations above the mean.…”

“…Perfusion SPECT/CT has been demonstrated to allow for functional lung avoidance during lung radiotherapy planning by several groups [8][9][10]. Recently, ventilation SPECT/CT has also been explored as a potential tool for functional lung avoidance by Munawar et al [11].…”

CT ventilation functional image-based IMRT treatment plans are comparable to SPECT ventilation functional image-based plans

“…For example, Seppenwoolde et al [35], Christian et al [36], and Shioyama et al [37] reported that SPECT perfusion functional image-based treatment planning resulted in a greater degree of sparing of highlyfunctional regions for patients with large perfusion defects. Munawar et al reported that SPECT ventilation functional image-based treatment planning resulted in a greater degree of sparing of highly-functional regions when overlap between the highlyfunctional regions and PTV was minimal and the PTV was not surrounded by highly-functional regions [38]. For future work, the sensitivity of the difference between the CT-functional and SPECT-functional plans should be investigated using a larger sample size with a broad spectrum of regional ventilation patterns, target sizes and locations.…”

Inclusion of functional information from perfusion SPECT improves predictive value of dose–volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer: A prospective study

“…SPECT/CT provides a quantitative assessment of the function in vascular/alveolar units [17][18][19]. Spatial heterogeneity of functional status on SPECT was used in RT planning in several studies [19][20][21][22][23][24][25]. These studies http://dx.doi.org/10.1016/j.radonc.2015.08.005 0167-8140/Ó 2015 Elsevier Ireland Ltd. All rights reserved.…”