CT-based delineation: What can we gain from state-of-the-art CT image acquisition and reconstruction techniques?

X-ray computed tomography (CT) has been the standard imaging modality in radiation oncology for both, treatment planning and delineation of targets and organs at risk for decades. For further improvement, especially for delineation, magnetic resonance imaging (MRI) and positron emission tomography (PET) are being extensively investigated and more often included into clinical routines. They can provide better soft tissue contrast and functional information. Still, also in the field of CT imaging relevant improvements have been made, that are not so much in the spotlight. Hence, this talk will focus on novel CT image acquisition and reconstruction techniques and their potential benefit for radiation oncology applications.
First, the potential value of dual-energy CT (DECT) for delineation will be discussed. DECT has already been proven to allow for a more accurate treatment planning, especially in particle therapy. It provides additional tissue information compared to conventional CT imaging. Furthermore, DECT enables the reconstruction of different CT datasets with varying image contrasts. Currently, it is unproven whether this additional information translates into improvement of the segmentation and delineation quality. The exploration of this benefit in combination with machine learning approaches is envisioned. First studies will be presented.
Second, the potential of iterative CT reconstruction methods will be highlighted. They allow for a substantial reduction of imaging dose to reach a similar noise level as conventional filtered back projection. Hence, iterative reconstruction is of high relevance for adaptive protocols as it reduces the dose burden from more frequent CT imaging during treatment.
Third, the value and challenges of metal artefact reduction algorithms will be covered. It has been shown that the visual image impression can be substantially improved for regions suffering from metal artefacts in conventional CT reconstruction, suggesting a direct benefit for delineation purposes. However, as these algorithms can also quantitatively alter the image in regions not influenced by metal artefacts, great care should be taken – especially in particle therapy planning.
In summary, state-of-the-art CT imaging can provide additional value for radiation oncology purposes. This talk aims to increase awareness of this potential. By revisiting the institutional imaging protocol, one can potentially improve the image quality for delineation and/or safe dose to patients.