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Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation.

Publication ,  Journal Article
Godfrey, DJ; Patel, BN; Adamson, JD; Subashi, E; Salama, JK; Palta, M
Published in: Pract Radiat Oncol
2017

PURPOSE: Bolus-tracked multiphasic contrast computed tomography (CT) is often used in diagnostic radiology to enhance the visibility of pancreas tumors, but is uncommon in radiation therapy pancreas CT simulation, and its impact on gross tumor volume (GTV) delineation is unknown. This study evaluates the lesion conspicuity and consistency of pancreas stereotactic body radiation therapy (SBRT) GTVs contoured in the different contrast phases of triphasic CT simulation scans. METHODS AND MATERIALS: Triphasic, bolus-tracked planning CT simulation scans of 10 consecutive pancreas SBRT patients were acquired, yielding images of the pancreas during the late arterial (LA), portal venous (PV), and either the early arterial or delayed phase. GTVs were contoured on each phase by a gastrointestinal-specialized radiation oncologist and reviewed by a fellowship-trained abdominal radiologist who specializes in pancreatic imaging. The volumes of the registered GTVs, their overlap ratio, and the 3-dimensional margin expansions necessary for each GTV to fully encompass GTVs from the other phases were calculated. The contrast difference between tumor and normal pancreas was measured, and 2 radiation oncologists rank-ordered the phases according to their value for the lesion-contouring task. RESULTS: Tumor-to-pancreas enhancement was on average much larger for the LA and PV than the delayed phase or early arterial phases; the LA and PV phases were also consistently preferred by the radiation oncologists. Enhancement differences among the phases resulted in highly variable GTV volumes with no observed trends. Overlap ratios ranged from 18% to 75% across all 3 phases, improving to 43% to 91% when considering only the preferred LA and PV phases. GTV expansions necessary to encompass all GTVs ranged from 0.3 to 1.8 cm for all 3 phases, improving slightly to 0.1 to 1.4 cm when considering just the LA and PV phases. CONCLUSIONS: For pancreas SBRT, we recommend combining the GTVs from a multiphasic CT simulation with bolus-tracking, including, at a minimum, a Boolean "OR" of the LA and PV phases.

Duke Scholars

Published In

Pract Radiat Oncol

DOI

EISSN

1879-8519

Publication Date

2017

Volume

7

Issue

6

Start / End Page

e489 / e497

Location

United States

Related Subject Headings

  • Tumor Burden
  • Tomography, X-Ray Computed
  • Radiotherapy Planning, Computer-Assisted
  • Radiosurgery
  • Pancreatic Neoplasms
  • Iopamidol
  • Humans
  • Contrast Media
  • Adenocarcinoma
  • 3211 Oncology and carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Godfrey, D. J., Patel, B. N., Adamson, J. D., Subashi, E., Salama, J. K., & Palta, M. (2017). Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation. Pract Radiat Oncol, 7(6), e489–e497. https://doi.org/10.1016/j.prro.2017.04.008
Godfrey, Devon J., Bhavik N. Patel, Justus D. Adamson, Ergys Subashi, Joseph K. Salama, and Manisha Palta. “Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation.Pract Radiat Oncol 7, no. 6 (2017): e489–97. https://doi.org/10.1016/j.prro.2017.04.008.
Godfrey DJ, Patel BN, Adamson JD, Subashi E, Salama JK, Palta M. Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation. Pract Radiat Oncol. 2017;7(6):e489–97.
Godfrey, Devon J., et al. “Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation.Pract Radiat Oncol, vol. 7, no. 6, 2017, pp. e489–97. Pubmed, doi:10.1016/j.prro.2017.04.008.
Godfrey DJ, Patel BN, Adamson JD, Subashi E, Salama JK, Palta M. Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation. Pract Radiat Oncol. 2017;7(6):e489–e497.
Journal cover image

Published In

Pract Radiat Oncol

DOI

EISSN

1879-8519

Publication Date

2017

Volume

7

Issue

6

Start / End Page

e489 / e497

Location

United States

Related Subject Headings

  • Tumor Burden
  • Tomography, X-Ray Computed
  • Radiotherapy Planning, Computer-Assisted
  • Radiosurgery
  • Pancreatic Neoplasms
  • Iopamidol
  • Humans
  • Contrast Media
  • Adenocarcinoma
  • 3211 Oncology and carcinogenesis