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Lung Cancer Diagnosis and Treatment / Advanced Radiotherapy Techniques · Journal article
Iium Medical Journal Malaysia · September 9, 2026
Early or partial results. Treat as a signal, not a conclusion.
This retrospective proof-of-concept study demonstrates technical feasibility and workflow reproducibility of a novel voxel-level ventilation-perfusion functional imaging technique for lung radiotherapy planning in 20 patients. VP-IMRT plans showed statistically significant reduction in high-function lung dose (V20Gy 81.03±56.03 to 61.14±64.44 Gy, p<0.001) compared to standard plans, but the study prioritizes technical validation over clinical outcome evidence and does not establish diagnostic accuracy versus established standards like SPECT V/Q imaging.
Retrospective proof-of-concept feasibility study. 20 lung cancer patients with 4D-CT and PET/CT scans available; institutional setting and eligibility criteria not specified. Intervention: Voxel-level ventilation-perfusion (VP) functional imaging integrated into IMRT treatment planning. Compared with: Standard single-modality (ventilation or perfusion alone) IMRT plans and organs at risk dosimetry. n = 20.
Automated VP-imaging workflow completed in 45±15 minutes per patient, meeting clinical efficiency requirements VP-IMRT significantly reduced ipsilateral high-function lung V20Gy from 81.03±56.03 to 61.14±64.44 Gy (p<0.001) versus standard IMRT Ventilation-VP and Perfusion-VP showed moderate-to-good agreement in whole and low-function lungs (DSC up to 0.71; r up to 0.943) but poor agreement in high-function regions
Dosimetric endpoints are surrogate measures; no clinical outcome data (recurrence, toxicity, survival) reported
This feasibility study provides technical proof-of-concept for functional imaging in RT planning but does not yet establish clinical utility or superiority over standard imaging. Prospective validation in larger cohorts and comparison to established functional imaging modalities (SPECT V/Q) would be needed before clinical implementation.
Proof-of-concept feasibility study in 20 patients demonstrating technical workflow validation and preliminary dosimetric advantages of a novel functional imaging approach, requiring confirmation in larger, prospective trials before clinical adoption.
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This feasibility study provides technical proof-of-concept for functional imaging in RT planning but does not yet establish clinical utility or superiority over standard imaging. Prospective validation in larger cohorts and comparison to established functional imaging modalities (SPECT V/Q) would be needed before clinical implementation.
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INTRODUCTION: Existing lung imaging lacks the dual assessment and spatial resolution needed for functional-avoidance radiotherapy. This proof-of-concept (PoC) feasibility study aimed to validate the technical feasibility of a novel voxel-level lung functional imaging technique based on ventilation-perfusion (VP) mapping and explore its preliminary utility in radiotherapy treatment planning. MATERIALS AND METHODS: We retrospectively analyzed 20 lung cancer patients with 4D-CT and PET/CT scans. Ventilation was calculated from 4D-CT deformable image registration, and perfusion from pre-processed PET images. High-function lung regions were defined as the top 40%. Three functional imaging modalities were generated: ventilation (V), perfusion (P), and VP imaging. The Dice Similarity Coefficient (DSC) and Bland-Altman plots evaluated agreement, and intensity-modulated radiation therapy (IMRT) plans were optimized for dosimetric comparison. RESULTS: The automated workflow took 45±15 minutes per patient, meeting clinical efficiency requirements. V-VP and P-VP showed moderate-to-good agreement in whole and low-function lungs (DSC up to 0.71; r up to 0.943) but poor agreement in high-function regions. VP-IMRT significantly reduced ipsilateral high-function lung V20Gy (81.03±56.03 to 61.14±64.44, p<0.001), with favourable dosimetric differences versus single-modality plans and no increased dose to organs at risk. CONCLUSION: VP-Imaging effectively integrates ventilation and perfusion data, establishes a reproducible workflow, and shows preliminary dosimetric advantages. This study prioritizes technical viability over diagnostic accuracy relative to SPECT V/Q, supporting the feasibility of VP-Imaging for personalized RT.
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