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PET/CT in RT Planning

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PET Scan in Hodgkin Lymphoma

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Abstract

Radiation therapy is a key component of combined modality therapy for Hodgkin’s lymphoma. In an effort to improve the therapeutic ratio and prevent late effects, radiation fields designed to encompass entire lymph node regions have recently been replaced with conformal methods of target volume delineation, known as involved-site radiation therapy (ISRT) and involved-node radiation therapy (INRT). Due to an increased risk of marginal misses with these new approaches, FDG-PET has become a critical aspect of modern radiation therapy planning, given its ability to identify areas of disease overlooked on CT. However, there are many challenges inherent to using PET for radiation planning. The current standard is a qualitative visual method, whereby PET/CT images are fused to the planning CT and the radiation oncologist contours target volumes using information from both image sets. Although not always possible, this method is best applied with input from an experienced radiologist or nuclear medicine physician given the complex nature of PET imaging and high rates of false positives. Due to a significant degree of inter- and intra-observer variability with this method, an effort has been made to explore the use of automated segmentation methods, which vary from simple standardized uptake value (SUV) cutoffs to more complex algorithms that incorporate signal-to-background ratios and sophisticated edge detection methodologies. This chapter covers the role of PET/CT in radiation planning for HL including automated and semiautomated contouring methods and the common pitfalls and artifacts in PET that are relevant when applied to radiation planning.

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Authors and Affiliations

  1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA

    Amanda J. Walker MD & Stephanie A. Terezakis MD

  2. Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, 401 N. Broadway, Suite 1440, Baltimore, MD, 21287, USA

    Stephanie A. Terezakis MD

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  1. Amanda J. Walker MD
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  2. Stephanie A. Terezakis MD
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Correspondence to Stephanie A. Terezakis MD .

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Editors and Affiliations

  1. Research, Innovation and Statistics, A. Lacassagne Cancer Center, Nice, France

    Andrea Gallamini

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Walker, A.J., Terezakis, S.A. (2016). PET/CT in RT Planning. In: Gallamini, A. (eds) PET Scan in Hodgkin Lymphoma. Springer, Cham. https://doi.org/10.1007/978-3-319-31797-7_5

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  • DOI: https://doi.org/10.1007/978-3-319-31797-7_5

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