PET/CT clinical research

In addition to routine PET CT scanning we are also dedicated to research in this field. We have published clinically orientated research projects in peer reviewed journals extensively over the years and presented our work at international conferences. With a second scanner coming in the summer of 2007 we will have the opportunity to do even more exciting work!

Additional research opportunities exist at the Paul Strickland Scanner Center through collaborations with the world renowned Gray Laboratories (cellular studies) and Mount Vernon Hospital (chemotherapy and radiotherapy treatment), both located on‘site here.

Here is a list of some of our clinical PET CT research projects

• PET CT integration into Radiotherapy Treatment Planning

It is conventional to plan radiotherapy treatment using X‘rays. However this looks at anatomical information (e.g. soft tissue) rather than functional information (such as glucose metabolism). In some cases during treatment tumour anatomy changes are slower to manifest than changes that occur in tumour metabolism.

There is evidence that more information may be available from FDG uptake than just CT anatomy alone for planning radiotherapy treatment. This may then help to isolate those patients for whom a different treatment regime may be more beneficial at an earlier date.

We have initiated research into integrating PET CT into radiotherapy treatment planning with our close colleagues in clinical physics at Mount Vernon Hospital located here on the same site.

There is evidence that more information may be available from FDG uptake than just CT anatomy alone for planning radiotherapy treatment. This may then help to isolate those patients for whom a different treatment regime may be more beneficial at an earlier date.

We have initiated research into integrating PET CT into radiotherapy treatment planning with our close colleagues in clinical physics at Mount Vernon Hospital located here on the same site.


• Breast Cancer Imaging

We have published results in the use of a proliferation marker called FLT and its application to observing changes in breast cancer during treatment. One aim is to see if we can identify patients who respond to treatment from those who do not. The non‘reponding patients can then have a different treatment regime at an earlier date. Again this utilises the abilty of functional information from the PET ( ie cell proliferation) predicting changes during treatment before anatomical changes manifest in CT images from PET CT.



The top row of images here show CT (left), PET (middle, with red arrow showing cancer) and fused PET CT (right) of breast cancer before treatment.

The bottom row of images are similar but show changes during treatment.

During treatment (second row of images) it can be seen that proliferation in the tumour has greatly decreased but the CT anatomical image does not reflect this. Such information could be of great use in future treatment planning.


• Head and Neck Cancer Imaging
We are dedicated to research in head and neck cancer at the Paul Strickland Scanner Centre. We also work closely with Professor Michele Saunders a renowned world leading expert in this field who has also pioneered radiotherapy treatment planning in the head and neck. Here are some head and neck research topics

Palatine Tonsil


In a few cases the primary site of cancer may not be visible with any imaging modality, however a lymph node may be enlarged etc to suggest there is a hidden primary cancer, ie an occult head and neck cancer. Unfortunately in such cases where the primary tumour is not located the prognosis can be poor.

Our group has developed a technique that investigates the potential incidence of occult primary head and neck cancer located in the palatine tonsil. We use the CT data from PET CT to locate the palatine tonsils over a number of slices. Then we draw regions around the tonsils and copy them onto PET images where we record the amount of FDG uptake in each tonsil (highlighted in white and shown as roi1 and roi2 in the image).



We have presented our results at national and international conferences and have submitted our results to a peer rewiewed journal for publication.



FDG uptake during radiotherapy


We are studying the effects of FDG uptake in head and neck tumours during a course of radiotherapy treatment in collbaoration with UCHL. This information will be useful in assessing metabolic changes to the tumour during treatment and helpful in determining if we can detect patients who do not respond to treatment and therby change their course of management earlier.

Additionally we can also use the PET CT data to see if there are advantages to using glucose metabolism information compared with standard CT data for radiotherapy treatment planning.



This example shows the CT (left) , PET (middle) and fused PET CT (right) images from a single slice through the tumour. The top row of images represent what occurs before treatment. The second row shows the tumour (marked in PET image) response during next scan during early treatment. The third and fourth rows show the tumour shrinks with less FDG uptake further along the course of treatment.



Cu64 uptake during radiotherapy


One problem with treating cancer is to distinguish what are called hypoxic regions where there are lower levels of oxygen present in the tumour. These regions are less likely to respond to treatment regimes and therefore the ability to locate hypoxia is desirable as one may modify treatment in these regions accordingly.

Here at the Paul Strickland Scanner Centre we are engaged in collaborative clinical research with UCHL and Guys and St Thomas's Hospitals to locate hypoxic regions in head and neck tumours that are potentially more resistant to conventional treatment.

In addition we can apply this information during a course of radiotherapy treatment and see if the level of hypoxia in cancer has any effect on the outcome of treatment. We are investigating a new radiopharmaceutical for visualing hypoxia called Cu-64 ATSM.




• CT dose reduction in PET CT

In conventional PET CT we routinely scan the whole body from the head to the groin as this helps to identify if the cancer has spread. In some cases we may need to scan more than once over a period of time, say during a course of treatment or during follow up. In such cases we may not need to scan the whole body but can scan a smaller section thereby reducing the radiation burden to the patient.

We are currently evaluating the potential for this and also the corresponding dose saving to the patient. Our technique utilises a Monte Carlo based dose saving calculator from the ImPACT group at St. George's Hospital in Tooting, London.




• Application of new radioisotopes for PET CT

At the Paul Strickland Scanner Centre we believe in adopting the latest research techniques to assist in clinical imaging studies.

With regards to this we have worked hard to secure new radiopharmaceuticals for studying proliferation i.e. FLT in breast cancer and Cu-64 ATSM for hypoxia in radiotherapy treatment planning in head and neck cancer.



Image of 18F‘fluoro‘3'‘deoxy‘3'‘L‘fluorothymidine ( FLT )


• NCRI National Trial ‘ The NHS Health Technology Assessment Programme, Department of Health

In recognition of our dedicated work in clinical PET CT over the years we have been designated the central core laboratory to inspect PET CT images from across the United Kingdom in a head and neck cancer trial starting in 2007. The Paul Strickland Scanner Centre will also perform quality control on all scans and design the PET CT scanning protocol for all other UK sites participating in the national trial.

Head and neck cancer and its treatments (chemotherapy and radiotherapy i.e. CRT) can have considerable effects on vital functions ‘ speech, eating, swallowing, appearance ‘ and therefore can result in significant functional deficits and quality of life effects. With advanced neck disease it is usual to perform a neck dissection (an operation to remove all lymph glands in the neck), either before or after the CRT. However, there is considerable debate related to whether a neck dissection is actually needed to treat the neck disease, or whether the CRT is sufficient to treat it without the need for the operation, which has considerable morbidity and a low but definite mortality.

One aim of the trial is to investigate the potential of using PET CT in a surveillance capacity and only performing a neck dissection if there is clinical evidence of persistent nodal disease after CRT.


• Optimising scanner operation

Our scanner can be operated in 2D or 3D mode. This choice offers the potential of optimised imaging for each patient depending upon their weight and size etc.

Doing a routine whole body PET CT scan

Then position the scanner couch so the tumour lies in the PET scanner field‘of‘view (FOV) centre
Then scan tumour for 4, 3 and 2mins in 2D and 3D (extra 20mins and no extra radiation dose)



We can then compare images of the tumour in 2D and 3D for different lengths of time scanned. This allows us to optimise the mode of scanner operation and also deduce the least time required to scan in head and neck cancer. This is useful when our patients are not feeling well or there is a low level of FDG remaining due to delays etc.



These images represent tumour FDG uptake for 2D (left column) and 3D (right column) scanning in head and neck cancer. The cancer can be seen as the red circles near the top of each image. Although the images look similar at 4, 3 and 2 min acquisition times there are subtle difference upon close inspection.

Publications in journals (since 2002)

National & International Oral Presentations (since 2002)

Here is some information about joint modality clinical research here