[18]F-fluoroethyl-L-tyrosine positron emission tomography for radiotherapy target delineation: Results from a Radiation Oncology credentialing program

Nathaniel Barry, Eng Siew Koh, Martin A. Ebert, Alisha Moore, Roslyn J. Francis, Pejman Rowshanfarzad, Ghulam Mubashar Hassan, Sweet P. Ng, Michael Back, Benjamin Chua, Mark B. Pinkham, Andrew Pullar, Claire Phillips, Joseph Sia, Peter Gorayski, Hien Le, Suki Gill, Jeremy Croker, Nicholas Bucknell, Catherine BettingtonFarhan Syed, Kylie Jung, Joe Chang, Andrej Bece, Catherine Clark, Mori Wada, Olivia Cook, Angela Whitehead, Alana Rossi, Andrew Grose, Andrew M. Scott

Research output: Contribution to journalArticlepeer-review


Background and purpose: The [18]F-fluoroethyl-L-tyrosine (FET) PET in Glioblastoma (FIG) study is an Australian prospective, multi-centre trial evaluating FET PET for newly diagnosed glioblastoma management. The Radiation Oncology credentialing program aimed to assess the feasibility in Radiation Oncologist (RO) derivation of standard-of-care target volumes (TVMR) and hybrid target volumes (TVMR+FET) incorporating pre-defined FET PET biological tumour volumes (BTVs). Materials and methods: Central review and analysis of TVMR and TVMR+FET was undertaken across three benchmarking cases. BTVs were pre-defined by a sole nuclear medicine expert. Intraclass correlation coefficient (ICC) confidence intervals (CIs) evaluated volume agreement. RO contour spatial and boundary agreement were evaluated (Dice similarity coefficient [DSC], Jaccard index [JAC], overlap volume [OV], Hausdorff distance [HD] and mean absolute surface distance [MASD]). Dose plan generation (one case per site) was assessed. Results: Data from 19 ROs across 10 trial sites (54 initial submissions, 8 resubmissions requested, 4 conditional passes) was assessed with an initial pass rate of 77.8 %; all resubmissions passed. TVMR+FET were significantly larger than TVMR (p < 0.001) for all cases. RO gross tumour volume (GTV) agreement was moderate-to-excellent for GTVMR (ICC = 0.910; 95 % CI, 0.708–0.997) and good-to-excellent for GTVMR+FET (ICC = 0.965; 95 % CI, 0.871–0.999). GTVMR+FET showed greater spatial overlap and boundary agreement compared to GTVMR. For the clinical target volume (CTV), CTVMR+FET showed lower average boundary agreement versus CTVMR (MASD: 1.73 mm vs. 1.61 mm, p = 0.042). All sites passed the planning exercise. Conclusions: The credentialing program demonstrated feasibility in successful credentialing of 19 ROs across 10 sites, increasing national expertise in TVMR+FET delineation.

Original languageEnglish
Article number100568
JournalPhysics and Imaging in Radiation Oncology
Early online date12 Mar 2024
Publication statusPublished - Apr 2024


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