Role of multimodality imaging in radiotherapy planning

Young K. Lee
Citation: Medical Physics 31, 1645 (2004); doi: 10.1118/1.1738171
View online: http://dx.doi.org/10.1118/1.1738171
View Table of Contents: http://scitation.aip.org/content/aapm/journal/medphys/31/6?ver=pdfcov
Published by the American Association of Physicists in Medicine
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ABSTRACTS OF RECENT Ph.D. THESES PERTINENT

TO MEDICAL PHYSICS
Appropriate thesis abstracts for this section should be submitted to Professor John Cameron, c/o Medical Physics, One Physics Ellipse, College Park, MD
20740-3846, with an electronic version sent, if possible, via e-mail to jrcamero@facstaff.wisc.edu with a copy to the Manuscripts Office at
journal@aapm.org.

Role of multimodality imaging in radiotherapy planning

Young K. Lee
Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Sutton, Surrey,
United Kingdom
Current address: Department of Medical Physics, Kent Oncology Centre, Maidstone Hospital, Maidstone,
Kent, United Kingdom
[E-mail: ylee@koc.mtw-tr.nhs.uk]
Thesis Advisors: Steve Webb, Maggie A. Flower, and Carl G. Rowbottom

Accurate tumor delineation is crucial to achieve successful radiotherapy RT. While CTs are
clinically used to plan 3DRT, multimodality imaging MMI promises to aid accurate delineation
of the tumor. This thesis examined delineated MMI volumes and studied their role in RT planning.
A prostate modeling study evaluated the dose reductions in conformal and intensity-modulated
radiotherapy CRT and IMRT due to interfractional gross tumor volume GTV motion and variability in delineation. In both CRT and IMRT, a 10 mm margin was adequate to account for
interfractional GTV movement. However, 10 mm CRT and 5 mm IMRT GTV misdelineation
produced unacceptable dose distributions. IMRT plans were more affected by delineation errors
when compared to CRT plans due to their steep dose gradients. Methods were developed to use
MRI only in RT planning. Water and bone electron density values were assigned to the image and
a low-distortion MR-sequence was used. MR-delineated prostate volumes were in general smaller
than those on CT by 10%. Patient data were separated into those that were affected by organ motion
from those that were not. An independent-organ registration technique was developed to relate CTand MR-delineated volumes that were affected by organ motion between the scans. The dosimetric
study showed that unacceptable CRT was planned using planning target volume delineated using
CT (PTVCT) when PTVMR volumes were assumed to be true. However, the dosimetric benefit was
small as a 12 mm marginal increase on PTVCT would deliver adequate dose to both PTVs and
insignificant dose reductions were observed in rectum and bladder when PTVMR plans were compared to PTVCT plans. The dosimetric effect of 123ImIBGSPECT in neuroblastoma CRT and
IMRT was studied. Reduction in tumor control probability due to incorrectly delineated neuroblastoma was observed and a new treatment was planned using PTVCTSPECT with acceptable doses to
OARs the organs-at-risk. IMRT delivered more conformal dose distributions to complex-shaped
PTVs compared to CRT. Methods required to add currently acquired diagnostic 18FFDGPET to
thoracic lymphoma RT planning were developed. The addition confirmed the inferior disease extension in 60% of the cases studied and in 20% of cases, presented a large inferior difference. The
addition of FDGPET would affect the field sizes and the extension of lead blocking. A theoretical
CRT study showed that greater than 50% decrease in lung dose was achievable with CRTPET when
compared to the original plan. This thesis highlighted not only the importance of using MMI in RT
planning but developed methods to cope with the additional information. Though not all the imaging modalities added a significant dosimetric benefit, they added new information regarding GTV
determination and decreased the subjectivity of GTV delineation with minimal technical difficulty,
which will benefit current RT planning.

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Med. Phys. 31 6, June 2004

0094-2405200431616453$22.00

2004 Am. Assoc. Phys. Med.

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