title: Integration of FDG-PET/CT into external beam radiation therapy planning: technical aspects and recommendations on methodological approaches.
abstract: This work addresses the clinical adoption of FDG-PET/CT for image-guided radiation therapy planning (RTP). As such, important technical and methodological aspects of PET/CT-based RTP are reviewed and practical recommendations are given for routine patient management and clinical studies. First, recent developments in PET/CT hardware that are relevant to RTP are reviewed in the context of quality control and system calibration procedures that are mandatory for a reproducible adoption of PET/CT in RTP. Second, recommendations are provided on image acquisition and reconstruction to support the standardization of imaging protocols. A major prerequisite for routine RTP is a complete and secure data transfer to the actual planning system. Third, state-of-the-art tools for image fusion and co-registration are discussed briefly in the context of PET/CT imaging pre- and post-RTP. This includes a brief review of state-of-the-art image contouring algorithms relevant to PET/CT-guided RTP. Finally, practical aspects of clinical workflow and patient management, such as patient setup and requirements for staff training are emphasized. PET/CT-guided RTP mandates attention to logistical aspects, patient set-up and acquisition parameters as well as an in-depth appreciation of quality control and protocol standardization.
  
  
  CONCLUSIONS
  Upon fulfilling the requirements to perform PET/CT for RTP, a new dimension of molecular imaging can be added to traditional morphological imaging. As a consequence, PET/CT imaging will support improved RTP and better patient care. This document serves as a guidance on practical and clinically validated instructions that are deemed useful to the staff involved in PET/CT-guided RTP.
authors.affiliation: University Hospital for Radiation Oncology, Section for Biomedical Physics, Eberhard-Karls University Tübingen, Germany. Daniela.Thorwarth@med.uni-tuebingen.de
authors.forename: D
authors.initials: D
authors.lastname: Thorwarth
authors.forename: T
authors.initials: T
authors.lastname: Beyer
authors.forename: R
authors.initials: R
authors.lastname: Boellaard
authors.forename: D
authors.initials: D
authors.lastname: de Ruysscher
authors.forename: A
authors.initials: A
authors.lastname: Grgic
authors.forename: J A
authors.initials: JA
authors.lastname: Lee
authors.forename: U
authors.initials: U
authors.lastname: Pietrzyk
authors.forename: B
authors.initials: B
authors.lastname: Sattler
authors.forename: A
authors.initials: A
authors.lastname: Schaefer
authors.forename: W
authors.initials: W
authors.lastname: van Elmpt
authors.forename: W
authors.initials: W
authors.lastname: Vogel
authors.forename: W J G
authors.initials: WJ
authors.lastname: Oyen
authors.forename: U
authors.initials: U
authors.lastname: Nestle
mesh_terms: D000465:Algorithms; D019788:Fluorodeoxyglucose F18; D006801:Humans; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D018511:Systems Integration; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18