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Current concepts on imaging in radiotherapy

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Abstract

New high-precision radiotherapy (RT) techniques, such as intensity-modulated radiation therapy (IMRT) or hadrontherapy, allow better dose distribution within the target and spare a larger portion of normal tissue than conventional RT. These techniques require accurate tumour volume delineation and intrinsic characterization, as well as verification of target localisation and monitoring of organ motion and response assessment during treatment. These tasks are strongly dependent on imaging technologies. Among these, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and positron emission tomography (PET) have been applied in high-precision RT. For tumour volume delineation and characterization, PET has brought an additional dimension to the management of cancer patients by allowing the incorporation of crucial functional and molecular images in RT treatment planning, i.e. direct evaluation of tumour metabolism, cell proliferation, apoptosis, hypoxia and angiogenesis. The combination of PET and CT in a single imaging system (PET/CT) to obtain a fused anatomical and functional dataset is now emerging as a promising tool in radiotherapy departments for delineation of tumour volumes and optimization of treatment plans. Another exciting new area is image-guided radiotherapy (IGRT), which focuses on the potential benefit of advanced imaging and image registration to improve precision, daily target localization and monitoring during treatment, thus reducing morbidity and potentially allowing the safe delivery of higher doses. The variety of IGRT systems is rapidly expanding, including cone beam CT and US. This article examines the increasing role of imaging techniques in the entire process of high-precision radiotherapy.

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Authors and Affiliations

  1. Institute of Radiological Sciences, University of Milan, Via Di Rudinì, 8 20142, Milan, Italy

    Michela Lecchi, Piero Fossati, Federica Elisei, Roberto Orecchia & Giovanni Lucignani

  2. Unit of Nuclear Medicine, San Paolo Hospital, Milan, Italy

    Michela Lecchi, Federica Elisei & Giovanni Lucignani

  3. CNAO Foundation, Milan, Italy

    Piero Fossati & Roberto Orecchia

  4. Department of Radiation Oncology, European Institute of Oncology, Milan, Italy

    Roberto Orecchia

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  1. Michela Lecchi
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  2. Piero Fossati
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  3. Federica Elisei
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  4. Roberto Orecchia
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  5. Giovanni Lucignani
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Correspondence to Giovanni Lucignani.

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Lecchi, M., Fossati, P., Elisei, F. et al. Current concepts on imaging in radiotherapy. Eur J Nucl Med Mol Imaging 35, 821–837 (2008). https://doi.org/10.1007/s00259-007-0631-y

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  • DOI: https://doi.org/10.1007/s00259-007-0631-y

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