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The reliability of quantitative thresholding methods for PET aided delineation of GTVs in Head and Neck tumours

Published online by Cambridge University Press:  24 May 2012

S. Barrett  and
R. Appleyard
S. Barrett*
Affiliation:
Radiation Therapy Department, Galway Clinic, Doughiska, Galway, Ireland
R. Appleyard
Affiliation:
Sheffield Hallam University, Sheffield, UK
*
Correspondence to: Sarah Barrett, Radiotherapy Department, Galway Clinic, Doughishka, Galway, Ireland. Tel: 00353 86 1712277/00353 91 785646, Fax: 00353 91 785573. Email: sarahbarrett43@gmail.com
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Abstract

Introduction: PET–CT scans are commonly used for the purpose of gross tumour volume (GTV) delineation in head and neck cancers. Qualitative visual methods (QVM) are currently employed in most radiotherapy departments but these are subject to inter- and intra-observer variability. Quantitative thresholding methods which appear in the published literature are evaluated with respect to their reliability for delineation of GTVs in head and neck cancers.

Discussion: Image segmentation involves the application of a distinct value to all pixels or voxels in an image dataset. This is a complex process affected by numerous variables. Some of the following segmentation thresholds may be applied to automatically delineate specified regions. Standardised uptake value (SUV) is commonly used to apply a threshold for GTV delineation, however this leads to inappropriately large GTVs. A further common quantitative threshold is based on the maximum signal on the PET image relative to the background uptake, known as signal to background ratio (SBR). This method generates GTVs that correlate well with surgically removed tumour volumes. Applying a fixed threshold of a percentage of the maximal intensity uptake is also documented in the literature but was found to be unsuitable for the purpose of head and neck GTV contouring. Systems based on the physical features of the PET-CT images are also discussed and are found to produce very promising results.

Conclusion: A number of quantitative techniques are evaluated and currently the most suitable is found to be SBR, however even this method was not found to be entirely reliable. More promising techniques need further evaluation before they could be implemented clinically and a Radiation Oncologist or Nuclear Medicine Radiologist must still validate all GTVs produced by quantitative methods.

Keywords

PET CTquantitative thresholdingPET aided delineationgross tumour volumeGTVhead and neck
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 12 , Issue 2 , June 2013 , pp. 187 - 194
Copyright
Copyright © Cambridge University Press 2012

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