A novel tool for motion-related dose inaccuracies reduction in 99mTc-MAA SPECT/CT images for SIRT planning

Introduction: In Selective Internal Radiation Therapy (SIRT), 90Y is administered to primary/secondary hepatic lesions. An accurate pre-treatment planning using 99mTc-MAA SPECT/CT allows the assessment of its feasibility and of the activity to be injected. Unfortunately, SPECT/CT suffers from patient-specific respiratory motion which causes artifacts and absorbed dose inaccuracies. In this study, a data-driven solution was developed to correct the respiratory motion. Methods: The tool realigns the barycenter of SPECT projection images and shifts them to obtain a fine registration with the attenuation map. The tool was validated using a modified dynamic phantom with several breathing patterns. We compared the absorbed dose distributions derived from uncorrected(Dm)/corrected(Dc) images with static ones(Ds) in terms of y -passing rates, 210 Gy isodose volumes, dose-volume histograms and percentage differences of mean doses (i.e., ADm and ADc, respectively). The tool was applied to twelve SIRT patients and the Bland-Altman analysis was performed on mean doses. Results: In the phantom study, the agreement between Dc and Ds was higher (y -passing rates generally > 90%) than Dm and Ds. The isodose volumes in Dc were closer than Dm to Ds, with differences up to 10% and 30% respectively. A reduction from a median ADm = -19.3% to ADc = -0.9%, from ADm = -42.8% to ADc =-7.0% and from ADm = 1586% to ADc = 47.2% was observed in liver-, tumor-and lungs-like structures. The Bland-Altman analysis on patients showed variations (+/- 50 Gy) and (+/- 4 Gy) between Dc and Dm of tumor and lungs, respectively. Conclusion: The proposed tool allowed the correction of 99mTc-MAA SPECT/CT images, improving the accuracy of the absorbed dose distribution.