Slide 1

May 28 30, 2015, Montral, Qubec Carol-Anne Davis, RT(T), AC(T), DHSA, MSc

Slide 2

May 28 30, 2015, Montral, Qubec I do not have an affiliation, financial or otherwise, with a pharmaceutical company, medical device or communications organization. I have no conflicts of interest to disclose ( i.e. no industry funding received or other commercial relationships). I have no financial relationship or advisory role with pharmaceutical or device-making companies, or CME provider. I will not discuss or describe in my presentation at the meeting the investigational or unlabeled ("off-label") use of a medical device, product, or pharmaceutical that is classified by Health Canada as investigational for the intended use.

Slide 3

PET-CT Over the past 20 years, positron emission tomography (PET) and PET/CT (computed tomography) have revolutionized the care of cancer patients in developed countries and are increasingly being adopted in emerging economies. *Permission granted from International Atomic Energy Agency: International Atomic Energy Agency, Standard Operating Procedures for PET/CT: A Practical Approach for Use in Adult Oncology IAEA Human Health Series 26, IAEA, Vienna (2013). PET has been, and still is, one of the fastest growing fields in medical imaging*

Slide 4

Research Question What proportion of non-small cell carcinoma lung and head & neck squamous cell carcinoma patients have a significantly different CTV due to the use of PET-CT?

Slide 5

Target Volumes: GTV, CTV high, low Extent of gross tumour, i.e. what can be seen, palpated or imaged; this is known as the gross tumour volume (GTV). Developments in imaging have contributed to the definition of the GTV.

Slide 6

Target Volumes: GTV, CTV high, low The second volume contains the GTV + a margin for sub-clinical disease spread which therefore cannot be fully imaged; this is known as the clinical target volume (CTV). It is the most difficult because it cannot be accurately defined for an individual patient, but future developments in imaging, especially towards the molecular level, should allow more specific delineation of the CTV. The CTV is important because this volume must be adequately treated to achieve cure.

Slide 7

Target Volumes: GTV, CTV

Slide 8

Target Volumes: GTV, CTV high, low GTV primary GTV nodes CTV high risk (requires max dose) CTV low risk (requires lower dose)

Slide 9

PET-CT is a powerful diagnostic imaging tool that combines anatomic imaging (CT) with physiologic data (PET) courtesy of G Segall (Stanford University) through the PET PROS program of the SNM PET Center of Excellence. http://www.snm.org/index.cfm?PageID=10044 PET-CT is sensitive and specific for cancer

Slide 10

PET Stands for positron emission tomography Fluorine-18-deoxyglucose (18-FDG), a radionuclide labeled glucose analogue, is injected and the pt is imaged 18F-fluorodeoxyglucose (FDG) is taken up by cells proportionate to their metabolic rates

Slide 11

Quite simply Malignant cells take inherently have a higher metabolism than non-malignant cells. They have a higher mitotic rate as well as more inefficient aerobic metabolism leading to more anaerobic metabolism Through these mechanisms, malignant cells will take up the FDG at a faster rate and this will can be seen on the scan as the FDG decays.

Slide 12

CT - Topogram (scout) - CT scan (1 min) PET - Brain (10 min) - Heart (10 min) - Body (20 min)