Flexible Magnetic Resonance (Imaging) (MR) hardware, such as body coils, can cause substantial attenuation of the Positron Emission Tomography (PET) signal in PET/MR imaging. Despite this, such hardware is typically not accounted for in clinical attenuation correction (AC), as its variable positioning and invisibility in standard MR sequences present significant challenges. In this study, we investigate the use of Maximum Likelihood Estimation of Attenuation and Activity (MLAA) guided registration of template hardware attenuation maps (μ-maps) to support AC for flexible hardware on PET data without Time Of Flight (TOF) information. Assuming the patient or phantom attenuation as known, attenuation maps beyond the patient outline were reconstructed from emission data and used as reference images for the non-rigid registration of pre-defined hardware template attenuation maps. The approach was evaluated and compared to the performance of MLAA-reconstructed attenuation alone on both phantom and patient data acquired on the Siemens Biograph mMR, including 18F-Fluorodeoxyglucose (18F-FDG) and 68Ga-DOTATATE tracers, and at various count levels. For the phantom data, both MLAA-only and MLAA-guided registration of template hardware attenuation maps improved quantification. Registration-based correction generally resulted in closer agreement with the ground truth, with residual errors of up to ≈5% that were largely localized, while MLAA-only reconstructions showed deviations of up to ≈10%, tending to be more spatially extended. The method also tolerates moderate errors in MR-based AC and non-physical deformations of the hardware template, with quantification most sensitive to gross misplacement of the hardware. These findings suggest that MLAA-guided registration offers a practical and effective solution to address the current gap in attenuation correction for flexible hardware in clinical PET/MR imaging, also in non-TOF settings.

To compare the performance of a multidisciplinary team (MDT) with the proposed standardized PROMISE classification system for indeterminate bone uptake on staging PSMA PET. 744 staging PSMA PET/CT scans (140 18F-PSMA-1007 and 604 68Ga-PSMA-11 PET/CT) were retrospectively reviewed for the presence of indeterminate bone metastatic staging. 95 scans which were discussed at an MDT meeting were further analysed for the comparison with the PROMISE classification system. MDT interpretation of the bone staging was recorded as positive or negative, based on risk stratification, imaging review, and clinically suitable management options. Additional resources were occasionally used, such as bone biopsy, musculoskeletal MRI, or re-evaluation after initial androgen deprivation therapy. MDT and PROMISE classification were compared for agreement. Statistical assessment was made on any differences in age, PSA, T-stage, Gleason score, risk, SUVmax and tracer used between negative and positive patients in both methods. Discordant cases were correlated with follow up data. The overall incidence of indeterminate bone uptake in staging PSMA PET scans was 16.9

Prostate cancer is the most commonly diagnosed cancer among men in 112 countries, accounting for approximately 15

Background: Despite relative successes in genomic-based precision oncological treatment, it is increasingly recognised that genomic data does not reflect all aspects of tumour biology. Deepening tumour phenotyping with [18F]FDG PET/CT beyond conventional imaging parameters, has the potential to further bridge the gap between current clinical and genomics-based strategies for precision oncology, and this study is an initial demonstration of this approach using colorectal cancer as a model. Methods: This multicentre, prospective observational study included 170 patients (58 females, 112 males, median age 66 years) with surgically confirmed colorectal cancer who underwent [18F]FDG PET/CT prior to resection. The patients’ tumour KRAS and RAS/RAF mutational status was determined. Kaplan-Meier analysis identified the most robust in vivo imaging markers of tumour metabolism and heterogeneity that were significantly associated with survival. P values were adjusted using the Benjamini-Hochberg procedure (false discovery rate 0·2). These markers were further and specifically tested in subsets of patients with known KRAS/RAS/RAF mutations for their ability to further predict outcome. Interpretation: Six imaging markers significantly stratified overall survival, with the most significant PET and CT parameters being Total Lesion Glycolysis (TLG; HR: 2·045, 95% CI: 1·209–3·460, p = 0·008) and Coarse texture (mean; HR: 2·071, 95% CI: 1·204–3·562, p = 0·009), respectively. These parameters also independently predicted outcome in patients with confirmed RAS/RAF mutation status, with TLG (≥ 149·445, p = 0·033) and coarse mean CT texture (< 21·58, p = 0·031) being associated with shorter survival. These findings suggest [18F]FDG PET/CT imaging phenotyping can enhance survival prediction in patients with colorectal cancer beyond genomic status.

Radiotherapy is a definitive treatment for POEMS syndrome with solitary plasmacytoma. However, data on its efficacy and the role of immunochemotherapy are limited. This study evaluated the treatment outcomes for POEMS patients receiving radiotherapy as their primary therapy and compared the results of those treated with adjunctive immunochemotherapy with those without. A retrospective analysis of patients with POEMS syndrome referred to University College London Hospital from 1998 to 2023 was conducted. Amongst 150 POEMS patients, 30 (20%) presented with solitary plasmacytoma. Sixteen patients (53%) received radiotherapy alone, whilst 14 (47%) had combined treatment with radiotherapy and immunochemotherapy, predominantly lenalidomide and dexamethasone (Rd). Treatment responses were greater in the combined treatment group, with clinical, VEGF, haematological, and radiological responses of 100%, 92%, 100%, and 100% respectively, compared to 87%, 92%, 85%, and 79% in patients receiving radiotherapy only. The median follow-up for the entire cohort was 124 months, with a 5-year overall survival (OS) rate of 100% and progression-free survival (PFS) rate of 82%. For those receiving radiotherapy alone, the median follow-up was 124 months with a 3-year PFS rate was 69%. In contrast, no progression was observed amongst patients treated with combined therapy during the follow-up period (range 7-54 months). Six patients experienced disease progression, all having received radiotherapy alone as their first-line treatment. This study demonstrated the high efficacy of radiotherapy in patients with POEMS syndrome and solitary plasmacytoma and highlighted the potential benefits of combining radiotherapy with immunochemotherapy.

Bladder cancer remains a major global health challenge, characterized by diagnostic uncertainty, substantial treatment costs and high recurrence rates. Current diagnostic and treatment modalities, including cystoscopy, transurethral resection of bladder tumour and standard histopathology, have limitations, including the inability to detect flat lesions, frequent understaging and interobserver variability, highlighting a crucial need for improved approaches. Advances in artificial intelligence (AI), blue-light cystoscopy, narrow-band imaging, cytology and urinary markers show promise in enhancing early detection and diagnosis. Developments in multiparametric MRI, radiomics, genomics and AI-driven algorithms for histopathological analyses have demonstrated considerable improvements in staging and risk stratification of bladder tumours, enabling personalized therapy selection and prognostication. Despite these promising developments, challenges remain regarding standardization, external validation, cost-effectiveness and ethical considerations in clinical implementation. Future research should prioritize addressing these barriers through collaborative, multi-institutional studies and robust validation frameworks. Ultimately, adopting a comprehensive multimodal strategy, such as proposed, novel, multimodal decision-making frameworks in which these advances and technologies are integrated, promises to considerably advance precision oncology in bladder cancer, improving patient outcomes and reducing health care burdens. In this Review, the authors describe and discuss how advances in artificial intelligence, genomics, radiomics and cytology can be integrated into decision-making processes to improve the management of bladder cancer.

Purpose:Functional imaging is central to the diagnosis and management of phaeochromocytomas and paragangliomas (PPGLs). This study aimed to compare the diagnostic performance of different functional imaging modalities for the detection of primary and metastatic PPGL. Methods:We conducted a retrospective, cross-sectional comparative study at a tertiary referral centre (2012-2023). Seventy three patients were with diagnosed with PPGL; 38 who underwent triple functional imaging. These 38 patients underwent 18F-FDG PET CT/MRI (FDG), and 68Ga-DOTATATE PET/CT (Dotatate), and 123I-mIBG SPECT/CT (mIBG). Per-patient detection rates for primary and metastatic disease were compared and correlated with SUVmax, metanephrine profiles and germline mutations. Results:Among the 38 patients who underwent triple functional imaging, 18 (47%) were women, with a median age of 41 years (range 11-81). There were 23 phaeochromocytomas and 15 paragangliomas. Overall detection rates were positive in 36/38 (94.7%) patients on FDG, 35/38 (92.1%) on Dotatate, and 34/38 (89.5%) on mIBG. Among patients with metastatic disease, lesion detection was observed in 16/16 (100%) with FDG, 12/13 (92.3%) with Dotatate, and 11/13 (84.6%) with mIBG. FDG SUVmax correlated significantly with plasma 3-methoxytyramine levels (r = 0.56, p = 0.0034) but not with normetanephrine or metanephrine. FDG demonstrated 100% detection in patients with SDHB (6/6) and VHL (3/3) mutations. Conclusion:In this study, FDG demonstrated the highest per-patient detection and the strongest association with aggressive biochemical and genetic phenotypes. These findings support an FDG-first functional imaging strategy for diagnosis and staging in PPGL, with additional targeted imaging reserved for theranostic decision-making.

Introduction Sentinel lymph node biopsy (SNB) maps tumour draining lymph nodes on an individual basis, identifying locations outside typical neck dissection levels including the contralateral neck. We report contralateral drainage and positivity rates in lateralised early oral cavity squamous cell carcinoma (OCSCC) and assess associations with tumour characteristics. Methods Single-centre retrospective study of patients with lateralised cT1-T2 OCSCC treated with wide local excision and SNB between February 2016 and January 2022. Data included tumour depth, distance to midline, lymphatic drainage, sentinel node number/location and SNB status. Variables were analysed using two-tailed Student t-tests and Fisher’s exact test, with Holm-Bonferroni correction where appropriate. Results Ninety-two patients underwent SNB; sixty-four met criteria for lymphatic drainage analysis. Contralateral or bilateral drainage occurred in twenty-six (40.6%) cases. Fifty (78.1%) tumours involved the anterior 2/3 tongue, with contralateral or bilateral drainage in twenty (40.0%).Twenty-two patients (34.4%) had positive SNB, including three (4.7%) with contralateral metastases. Mean follow-up was 46.3 months. One- and three-year overall survival were 93.7% and 77.8%; disease-free survival was 91.7% and 80.0%. One patient (1.5%) had a false-negative SNB, and three (4.7%) would have been inadequately staged or treated by ipsilateral elective neck dissection. Discussion Contralateral drainage was common in lateralised early OCSCC, although contralateral positivity was uncommon. SNB may improve individualised staging by identifying clinically relevant contralateral drainage not addressed by ipsilateral elective neck dissection. Prospective multicentre studies are needed to define anatomical and tumour-related predictive factors for contralateral drainage.

Background/Objectives: Head and neck sarcomas account for 11% of all soft tissue and 9% of all bone sarcomas in the UK. Diagnostic delays are common, with non-specific symptoms and histological misdiagnosis reported in up to 42% of cases. This study aims to evaluate the association between presenting symptoms, symptom duration, and tumour size to inform a tailored HNS diagnostic strategy for early referral to a tertiary centre. Methods: We analysed a retrospective cohort of 425 adult and paediatric patients referred to the London Sarcoma Service between 2002 and 2025. Results: Our cohort analysis identified a median tumour size of 44.00 mm and symptom duration of 3 months. Although symptom duration did not predict tumour size (β = 0.63, p = 0.76), non-specific symptoms (swelling, pain, nasal/oral changes) were significantly associated with larger tumours (OR 1.96-3.66), alongside systemic symptoms (β = 22.90 mm, p = 0.044). Each 1 mm increase in tumour size was also associated with a 2.60% increased chance of a higher-grade sarcoma (OR = 1.03 per mm, p < 0.001). Conclusions: To our knowledge, this is the largest cohort study to characterise diagnostic patterns in HNS. Our findings reveal three critical insights: 1. Current size-based referral thresholds are inadequate. 2. Non-specific symptoms, such as nasal or oral symptoms, are frequently overlooked. 3. The anatomical complexity of the HN region demands early tailored diagnostic strategies. We propose a hypothesis-generating '1-2-1' framework to support earlier clinical suspicion, which requires prospective validation.

BACKGROUND:Splenomegaly is an important finding in numerous conditions. Most reported cohort studies have not included modern diagnostic methods, such as functional imaging. AIM:We aimed to determine the utility of newer diagnostic methods and provide an updated approach to splenomegaly by examining recent experience at our centre. METHODS:We conducted a retrospective review of adult patients with splenomegaly of unknown cause using imaging reports over 12 months. We used an upper limit of 13 cm and applied a validated height- and sex-adjusted formula (SplenoCalc) where possible. Data were analysed using Fisher's exact test on Graphpad Prism software. RESULTS:Liver pathology was identified in 24%, infectious disease in 19%, haematological disease in 18%, inflammatory disease in 8% and no diagnosis in 28%. Patients who had an 18-F-fluorodeoxyglucose positron emission tomography (FDG PET) scan were significantly more likely to undergo a biopsy (25/38 vs. 23/103, P < 0.0001) and reach a diagnosis (34/38 vs. 84/126, P = 0.007). Eight per cent of assessable patients had a spleen size within normal limits when the SplenoCalc formula was applied. Untreated human immundodeficiency virus (HIV) was identified in 8% of tested patients. CONCLUSION:In our cohort, PET scanning, where appropriate, was valuable in identifying sites for biopsy and establishing a cause for splenomegaly, particularly haematological or inflammatory. Routine recording of height and use of the SplenoCalc formula in imaging departments may avoid unnecessary investigation of people with normal sized spleens. Due to the prevalence of untreated HIV in our cohort, we would also recommend HIV testing in all patients with splenomegaly.

It is challenging to identify which patients with Stage II colorectal cancer (T3N0M0 and T4N0M0) are at high risk of recurrence and might benefit from additional therapies. This preliminary study examines whether multiparametric [18F]FDG PET/CT is superior to T-stage in predicting overall survival in this patient group. This multicentre, prospective observational study included 66 patients (41 male, 25 female, mean age 69.1 ± 10.3yrs) with biopsy-proven Stage II colorectal cancer who underwent [18F]FDG PET/CT prior to resection. Kaplan-Meier analysis was performed on PET and image texture parameters and clinico-histopathological markers to identify associations with survival. P-values were adjusted using the Benjamini-Hochberg procedure, and the most statistically significant radiomic parameters underwent 3-fold cross-validation. Multivariate Cox regression analysis was used to determine independence of prognostic markers. 49 patients survived the follow up period, with a mean overall survival of 88.4 (± 42.3 months). Univariate analysis showed no significant survival association with clinical variables such as patient sex (p = 0.295), age (p = 0.085), tumour side (p = 0.662), location (p = 0.848) or volume (p = 0.782), or high-risk histopathological metrics including low number lymph node sampling (p = 0.363), perineural, lymphovascular or extramural tumour invasion (p = 0.196), poor tumour differentiation (p = 0.372), and tumour perforation (p = 0.475). No significant survival difference was observed between T3 and T4-stages (p = 0.748). An increased mortality risk was observed for patients with a pixel mean intensity < 20.390 on CT texture (coarse texture scale), HR: 3.40 (1.36–8.49); p = 0.005, and where SUVmax ≥ 25.560 g/mL on [18F]FDG PET/CT, HR: 3.45 (1.31–9.12); p = 0.008. These parameters remained significant after 3-fold cross validation and were independent predictors of survival after Multivariate Cox regression analysis. A higher mortality risk was indicated when the parameters were combined (5 of 66 patients), hazard ratio: 5.44 (1.75–16.91); p = 0.001. Multiparametric [18F]FDG PET/CT can potentially provide prognostic markers for patients with stage II colorectal cancer with superior risk stratification compared to T-stage.

Treatment with radioactive drugs (molecular radiotherapy, MRT) is an option for selected children with neuroblastoma and neuroendocrine cancers. As few hospitals are appropriately equipped and staffed to provide paediatric MRT, many families have to travel long distances from home for prolonged periods. To improve professional understanding of the challenges faced by children receiving these treatments and their parents, and to help them appreciate the difficulties faced by professionals in delivering complex treatments, a meeting bringing together parents, patients and professionals was held. Ten people (five parents of children with neuroblastoma, two parents of children with neuroendocrine cancers, two adults who had received treatment for neuroendocrine cancers in childhood and one adult treated for neuroblastoma) gave personal perspectives of treatment with MRT. Three professionals from different disciplines involved with this treatment and research to improve its results gave their views on the administration of MRT, and how treatment outcomes might be improved. Fifteen people, including parents and professionals, contributed to the general discussion. Following the meeting, a questionnaire was circulated to those attending to capture their overall views, and any reflections they may have had after the meeting. Whilst many positive comments and compliments were received, this report focuses on the reported challenges and difficulties. The event is an example of meaningful Patient and Public Involvement and Engagement and has resulted in development of better information resources, strategies to mitigate inconveniences experienced and a standing group of advocates to advise on research design and acceptability.

Despite improvements in neuroblastoma treatment, survival figures lag behind those of many other childhood malignancies. New treatments, and better use of existing treatments, are essential to reduce mortality. Neuroblastoma expresses several molecular targets for radionuclide imaging and therapy, of which the most widely exploited is the norepinephrine transporter. [123I]metaiodobenzylguanidine (MIBG) imaging and [131I]MIBG treatment, which target this physiologic pathway, have been in clinical practice for 40 y. Although therapy outcomes have been favorable, [131I]MIBG use has not yet been optimized. Somatostatin receptors and the disialoganglioside are alternative targets, but their use remains experimental. The charity Children's Cancer Research Fund organized a workshop bringing together a broad range of scientists including radiochemists, radiobiologists, radiation physicists, clinical researchers including pediatric oncologists and nuclear medicine physicians, and patient advocates from the United Kingdom, United States, and continental Europe to share their experiences with molecular imaging and radiotherapy of neuroblastoma and discuss potential ways of improving treatment outcomes and access. These include development of alternative vectors targeting somatostatin receptors and disialoganglioside, isotopes such as α-particle and Auger electron emitters with different radiation characteristics, and combinations with external-beam radiotherapy, immunotherapy, and DNA damage repair inhibitors. Barriers to progress discussed included the unpredictable radioisotope supply, production of novel radiopharmaceuticals, lack of data regarding which are the best combination therapies, and insufficient clinical facilities. The aim was to stimulate the development and assessment of more effective treatments.

Introduction Treatment of the node negative contralateral neck in oropharyngeal cancer (OPC) remains debated, with no clear consensus. Prophylactic contralateral neck treatment (either surgically or via irradiation) is generally recommended when the estimated risk of occult nodal metastasis is >20%. Unfortunately, patients undergoing bilateral neck treatment often require long-term supportive care for swallowing dysfunction. Reducing the impact of treatment on long-term quality of life is key in patients with OPC who have a good prognosis and tend to be young and fit at presentation. Lymphatic mapping and the use of free-hand single photon emission CT (fhSPECT) combined with sentinel lymph node biopsy is a novel approach to address this clinical need. The Lymphatic mapping Of Oropharyngeal Cancer trial aims to (a) validate a lymphatic mapping protocol in OPC using new technology (fhSPECT) with radiotracers and (b) establish lymphatic drainage patterns and the occult metastatic rate in the contralateral neck in OPC.Methods and analysis The design is a prospective multicentre cohort trial to understand the lymphatic drainage pattern in 150 patients with OPC and unilateral neck metastases. The trial has two phases: (1) imaging phase (n=75)—aim: develop an imaging protocol to establish the lymphatic drainage pattern in a population of patients with proven unilateral neck metastasis from OPC. The intervention will involve peritumoural injection of radiotracer followed by fhSPECT scan under general anaesthesia (GA) (at time of examination under anaesthetic). A SPECT/CT scan (gold standard for lymphatic mapping) will be carried out subsequently as a comparator. The primary outcome is the rate of contralateral drainage. Secondary outcome is the accuracy of fhSPECT versus SPECT/CT. The number of contralateral nodes on SPECT/CT will be used as the denominator in calculating the sensitivity of fhSPECT in independently verified images. fhSPECT should achieve sensitivity >94%. A minimum number of 20/75 patients will be required to demonstrate contralateral drainage to proceed to the surgical stage. An imaging substudy (n=20) aims to develop a secondary imaging protocol in the event of <94% sensitivity of intraoperative fhSPECT. To investigate the sensitivity of outpatient imaging (single injection of radiotracer and SPECT/CT) compared with gold standard (SPECT/CT from initial imaging phase) and the acceptability of outpatient injection compared with under GA. Twenty patients from the imaging phase with easily accessible tumours will be invited to undergo a second imaging; (2) Surgical phase (n=75)—aim: demonstrate the utility of surgically staging the contralateral neck using sentinel node biopsy (SNB). The primary outcome of this surgical phase is the occult metastatic rate of contralateral nodes (positive SNB). The contralateral drainage rate will be identified during the imaging phase, with an expected SNB positive rate of excised nodes ranging from 25% to 40%.Ethics and dissemination The outcome of this trial will provide a validated protocol and evidence to inform the design of future research in which management of the contralateral neck is based on surgical staging. Ethical approval was granted by the Yorkshire & The Humber-South Yorkshire Research Ethics Committee (REC ref: 20/YH/0111). Results from the trial will be presented to the scientific community at appropriate meetings and international journals. Patients and the public will be informed via patient groups, cancer charities and social media/press releases.Trial registration number NCT04498221.

Prostate-specific membrane antigen (PSMA) is upregulated in prostate cancer cells relative to other cells. The increased expression and enzymatic activity of PSMA in high-stage disease confers a selective advantage on such cells, contributing to their increased proliferation, the tendency to metastasize and the development of a castration-resistant phenotype. The decades of radiobiochemical advances in the development of PSMA targeting radiolabelled ligands has led to the subsequent FDA approval of a number of radiotracers and radiotherapeutics for clinical use. Novel developments in therapeutic advances using PSMA-based combinatorial approaches include PSMA-targeted antibody–drug conjugates and PSMA-targeted radionuclide payloads. Combining and sequencing some of these strategies with standard therapy options such as surgery, radiotherapy and androgen receptor pathway inhibitors could improve patient outcomes. Immunotherapy and chimeric antigen receptor T cell therapy are relevant to PSMA-based therapies as PSMA can serve as a specific target antigen for these treatments, enabling precise tumour recognition and enhanced efficacy of prostate cancer therapies. In this Perspective, the authors evaluate the current status of prostate-specific membrane antigen (PSMA) ligand-enabled imaging, summarizing novel developments, therapeutic advances and combinatorial approaches. The potential future role of PSMA-based strategies in the future management of prostate cancer is also discussed.

Purpose Paraganglioma, phaeochromocytoma and gastroenteropancreatic neuroendocrine tumours are rare in childhood. Molecular radiotherapy is one potential treatment for locally inoperable or metastatic disease. This study reviews the use and efficacy of molecular radiotherapy with both [ 131 I] meta iodobenzylguanidine (mIBG) and [ 177 Lu] DOTATATE in this patient group. Methods This is an observational cohort study of all patients aged less than 18 years with adult type metastatic neuroendocrine cancers treated with molecular radiotherapy from 2003 to 2023 in one national referral centre. Results Twelve patients, six male and six female, were treated. The median age at diagnosis was 12 years 3 months (range 7 years 11 months to 15 years 5 months), and at first molecular radiotherapy treatment was 13 years 7 months (range 8 years 8 months to 16 years 2 months). Nine had paraganglioma or phaeochromocytoma, three had other neuroendocrine tumours. Three received [ 177 Lu] DOTATATE only, four received [ 131 I] mIBG only, and five received both radiopharmaceuticals. Three patients had rapid disease progression and died within a year. Following initial treatment of the others, two had a complete response, four had a partial response, one had stable disease, and two had a mixed response. Nine patients remain alive, at a median of 5 years 0 months (range 2 years 4 months to 21 years 5 months) after start of treatment. Conclusion Molecular radiotherapy can be beneficial, and may provide good disease control for long periods in a proportion of these patients. Combining different radiopharmaceuticals may be of value.

OBJECTIVE:Globally, head & neck sarcoma care pathways remain unclear. In 2018, the London Sarcoma Service (LSS) set up a dedicated head and neck sarcoma (HNS) multidisciplinary team (MDT) with a clear objective to provide formal access to super-specialist expertise in diagnosis, treatment planning and management of HNS. The aim of the study is to provide first results of a dedicated HNS MDT. METHODS:All patients discussed between 2018 and 2022, in HNS MDT, with a new histologically confirmed HNS diagnosis were included in the study. Demographics, anatomic site, morphology, MDT recommendation, treatment details and outcomes were obtained from electronic patient records. RESULTS:A total of 337 patients were discussed in the HNS MDT of which 178 patients were included in the study, with a median age of 53 years(range 2-94); 67 % were soft tissue sarcomas(STS) and 33 % were bone sarcomas(BS), of which 43 % and 71 % were high grade, respectively. 55 % BS and 39 % STS underwent surgery. 9 % of BS and 7 % of STS received adjuvant Proton Beam therapy. With a median follow-up of 2.16 years, recurrence was observed in 12 %, distant metastasis in 6 % of patients and overall survival was 72 %. CONCLUSION:The HNS MDT provides expertise on diagnosis and multi-modality management of HNS. STS are more likely to be misdiagnosed. Atypical imaging characteristics should trigger a specialist referral. Adequate surgery at first presentation remains the mainstay of treatment and the strongest prognosticator of overall survival. Formation of an expert working group specific to HNS must work towards streamlining sarcoma care.

Complex dual cardiac and respiratory movement is a challenge for PET/CT imaging of coronary plaques. When using dual-gating, respiratory motion correction (RMC) is essential to reduce blurring, but this is not yet available in vendor software. Moreover, existing vendor methods for RMC either ignore attenuation mismatch or require external devices to obtain matched PET and CT. This study investigates a method for cardiac PET/CT motion estimation and motion correction that uses gated PET in combination with cine-CT obtained without external monitoring. This methodology will be incorporated into an open-source software platform. 68GaDOTATATE PET/CINE-CT were acquired for 24 patients with identified coronary plaques. A respiratory motion model was derived from the cine-CT data after sorting via intensity analysis. Motion parameters were derived from respiratory gated non-attenuation corrected PET images. The resulting deformations were then applied to the CT data, which were used to obtain respiratory motion and attenuation corrected PET images. The effectiveness of our method was verified by comparing key metrics Root Mean Squared Error and Foot-to-head profiles in liver dome before and after the application of the motion model.