| Summary: | The advent of hybrid PET/CT scanners, with coregistered functional and anatomical data, has revolutionized the management of cancer treatment and
opened new possibilities for target volume delineation in radiation oncology. This
thesis examined how PET/CT can be utilized for treatment planning in the General
University Hospital of Patras and how the clinical workflow can be simplified and
improved. Initially, this was achieved by conducting a literature study, where
articles describing PET/CT in cancer treatment were investigated. These included
the essential parameters required in image acquisition for radiotherapy purposes,
such as consistency of table tops, use of laser lights, patient’s initial positioning,
use of appropriate immobilization devices and data transfer. For this RT-oriented
PET/CT procedure, certain limitations and pitfalls were also reviewed. In addition,
special attention was given to the collaboration between the nuclear medicine and
the radiation therapy department on all levels of interaction. The second part of this thesis concerns the clinical implementation, which started with a presentation of misregistered PET and CT image sets of patients on our department, prior to implementing PET/CT setup in treatment position. Then, a CT-to-ED calibration
was performed for the PET/CT scanner, using the Gammex 467 phantom, to
accurately account for tissue heterogeneities. Afterwards, a phantom dry-run test
was carried out, using the NEMA NU2 phantom, to assess the feasibility of the process of PET/CT performed in treatment position and evaluate its potential to
proceed with head and neck cancer patients. So, before the enrollment of the first
patient, the current clinical head and neck protocol had to be extended, in order to
meet the requirements for radiotherapy planning. Lastly, several feasibility studies
were performed with a few head and neck cancer patients, to highlight all the
practical issues that need be addressed, so that the procedure can be safely introduced into routine clinical practice. Overall, this thesis can serve as a guidance on practical and clinically validated instructions, which can be deemed useful to the staff involved in the PET/CT-guided radiation treatment planning of our department, as well as to other institutions that wish to follow the same steps and perform a similar procedure.
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