Impact of PET reconstruction algorithm and threshold on dose painting of non-small cell lung cancer

Ingerid Skjei Knudtsen*, Wouter van Elmpt, Michel Ollers, Eirik Malinen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


PURPOSE: In the current work, we investigate the impact of PET reconstruction methods (RMs) and threshold on two types of dose painting (DP) prescription strategies for non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS: Sixteen patients with NSCLC underwent an 18F-FDG-PET/CT examination prior to radiotherapy. Six different RMs were used. For both a dose painting by contours (DPBC) and a dose painting by numbers (DPBN) strategy, the prescribed radiation dose within the gross tumor volume (GTV) was mapped according to the spatial distribution of standardized uptake values (SUVs). SUVmax and SUVpeak were used for volume thresholding in DPBC and a linear SUV-dose scaling approach was used for DPBN. Deviations from the dose prescription as determined by the standard RM was scored by a quality factor (QF).

RESULTS: For DPBC, the mean difference in thresholded boost volume between RMs was typically within 10%. The difference in dose prescription was systematically lower for thresholding based on SUVpeak (largest mean QF 2.8±2.0%) compared to SUVmax (largest mean QF 3.6±3.0%). For DPBN, the resulting dose prescriptions were less dependent on RM and threshold; the largest mean QFs were 1.3±0.3% both for SUVmax and SUVpeak.

CONCLUSIONS: PET reconstruction algorithms will both influence DPBC and DPBN, although the impact is smaller for DPBN. For some patients, the resulting variations in dose prescriptions may result in clinically different dose distributions. SUVpeak is a more robust thresholding parameter than SUVmax.

Original languageEnglish
Pages (from-to)210-4
Number of pages5
JournalRadiotherapy and Oncology
Issue number2
Publication statusPublished - Nov 2014


  • Algorithms
  • Carcinoma, Non-Small-Cell Lung
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms
  • Positron-Emission Tomography
  • Radiation Dosage
  • Radiopharmaceuticals
  • Radiotherapy Planning, Computer-Assisted
  • Retrospective Studies


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