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British Journal of Radiology (2006) 79, 554-561
© 2006 British Institute of Radiology
doi: 10.1259/bjr/48822193
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Advanced imaging applied to radiotherapy planning in head and neck cancer: a clinical review

K Newbold, MRCP, FRCR 1 M Partridge, PhD, CPhys 2 G Cook, MD, FRCP, FRCR 2 S A Sohaib, BSc, MRCP, FRCR 1 E Charles-Edwards, MSc, CSci 2 P Rhys-Evans, FRCS 1 K Harrington, MRCP, FRCR 1 and C Nutting, MD, MRCP, FRCR 1

1 The Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, 2 The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, UK


Figure 1
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  		Figure 1. Three-dimensional conformal radiotherapy planning. CT plan of a left sided oropharyngeal tumour. Blue colourwash: planning target volume (PTV), isodose levels indicated by coloured linear boundaries. ANT: anterior beam, LAO: left anterior oblique, LPO: left posterior oblique.

 

Figure 2
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  		Figure 2. 18FDG PET/CT case study. This patient presented with a right sided level II node containing metastatic squamous cell carcinoma. Conventional imaging with a diagnostic contrast enhanced CT scan showed the right neck node but the primary tumour was occult. (a) The non-contrast enhanced CT component of the PET/CT scan illustrates this (arrow points at node). (b) 18FDG PET/CT demonstrated the right neck node and but also identified an area of 18FDG uptake in the right tongue base which on biopsy was proven to be the primary site. (c) The planning target volume (PTV) defined in blue shows the target volume planned with conventional data only whereas the PTV defined in green shows the expansion of this when the PET/CT identifies the tongue base tumour and therefore includes the oropharynx and contralateral neck. The PTV increased by 467 cm3 with the addition of data from the PET/CT.

 

Figure 3
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  		Figure 3. Hardware-fused 18FDG-PET/CT showing primary tumour in the left oropharynx. The position of the 18FDG uptake can be seen in relation to the CT derived anatomy in three dimensions.

 

Figure 4
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  		Figure 4. Intensity-modulated radiotherapy (IMRT) plan, illustrating dose boost to a biological target volume (BTV).

 

Figure 5
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  		Figure 5. Interaction of anatomical and functional imaging modalities and their compatibility with radiotherapy planning(RTP).

 




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