Breathing-induced Errors in Quantification and Description of Dominant Intra-Prostatic Lesions (Dils) in PET Images: A Simulation Study by Means of The 4D NCAT Phantom.

Background: Respiratory movement and the motion range of the diaphragm can affect the quality and quantity of prostate images. Objective: This study aimed to investigate the magnitude of respiratory-induced errors to determine Dominant Intra- prostatic Lesions (DILs) in positron emission tomography (PET) images. Material and Methods: In this simulation study, we employed the 4D NURBS-based cardiac-torso (4D-NCAT) phantom with a realistic breathing model to simulate the respiratory cycles of a patient to assess the displacement, volume, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), signal to noise ratio (SNR), and the contrast of DILs in frames within the respiratory cycle. Results: Respiration in a diaphragm motion resulted in the maximum superior-inferior displacement of 3.9 and 6.1 mm, and the diaphragm motion amplitudes of 20 and 35 mm. In a no-motion image, the volume measurement of DILs had the smallest percentage of errors. Compared with the no-motion method, the percentages of errors in the average method in 20 and 35 mm- diaphragm motion were 25% and 105%, respectively. The motion effect was significantly reduced in terms of the values of SUVmax and SUVmean in comparison with the values of SUVmax and SUVmean in no- motion images. The contrast values in respiratory cycle frames were at a range of 3.3-19.2 mm and 6.5-46 for diaphragm movements' amplitudes of 20 and 35 mm. Conclusion: The respiratory movement errors in quantification and delineation of DILs were highly dependent on the range of motion, while the average method was not suitable to precisely delineate DILs in PET/CT in the dose-painting technique.

Evaluation of Dose-Painting in the Dominant Intraprostatic Lesions by Radiobiological Parameters using 68Ga- PSMA PET/CT.

Background: Patients diagnosed with dominant intraprostatic lesions (DIL) may need radiation doses over than 80 Gy. Dose-painting by contours (DPC) is a useful technique which helps the patients. Dose-painting approach need to be evaluated. Objective: To evaluate the DCP technique in the case of boosting the DILs by radiobiological parameters, tumor control probability (TCP), and normal tissue complication probability (NTCP) via PET/CT images traced by 68Ga-PSMA. Material and Methods: In this analytical study, 68Ga-PSMA PET/CT images were obtained from patients with DILs that were delineated using the Fuzzy c-mean (FCM) algorithm and thresholding methods. The protocol of therapy included two phases; at the first phase (ph1), a total dose of 72 Gy in 36 fractions were delivered to the planning target volume (PTV1); the seconds phase consisted of the application of variable doses to the PTV2. Moreover, two concepts were also considered to calculate the TCP using the Zaider-Minerbo model. Results: The lowest volume in DILs belonged to the DIL1 extracted by the FCM method. According to dose-volume parameters of the rectum and bladder, by the increase in the PTV dose higher than 92 Gy, the amounts of rectum and bladder doses are increased. There was no difference between the TCPs of DILs at doses higher than 86 Gy and 100 Gy for ordinary and high clone density, respectively. Conclusion: Consequently, our dose-painting approach for DILs, extracted by the FCM method via PET/CT images, can reduce the total dose for prostate radiation with 100% tumor control and less normal tissue complications.