Evaluation of MVCT images with skin collimation for electron beam treatment planning

This study assessed the potential of using megavoltage CT (MVCT) images taken with high density skin collimation in place for electron beam treatment planning. MVCT images were taken using the TomoTherapy Hi-Art system (TomoTherapy Inc., Madison, WI), and the CT numbers were converted to density by calibrating the Hi-Art system using an electron density phantom. Doses were computed using MVCT images and kVCT images and compared by calculating dose differences in the uniform dose region ( > 90%, excluding buildup region) and calculating distance-to-agreement (DTA) in high dose-gradient regions (penumbra and distal falloff, 90%-10%). For 9 and 16 MeV electron beams of 10 x 10 cm calculated on a homogeneous CIRS Plastic Water (Computerized Imaging Research Systems Inc., Norfolk, VA) phantom without skin collimation, the maximum dose differences were 2.3% and the maximum DTAs were 2.0 mm for both beams. The same phantom was then MVCT scanned nine times with square skin collimators of Cerrobend on its surface - field sizes of 3 x 3, 6 x 6, and 10 x 10 cm and thicknesses of 6, 8, and 10 mm. Using the Philips Pinnacle 3 treatment planning system (Philips Medical Systems, N.A., Bothwell, WA), a treatment plan was created for combinations of electron energies of 6, 9, 12, and 16 MeV and each field size. The same treatment plans were calculated using kVCT images of the phantom with regions-of-interest (ROI) manually drawn to duplicate the sizes, shapes, and density of the skin collimators. With few exceptions, the maximum dose differences exceeded +/-5% and the DTAs exceeded 2 mm. We determined that the dose differences were due to small distortions in the MVCT images created by the high density material and manifested as errors in the phantom CT numbers and in the shape of the skin collimator edges. These results suggest that MVCT images without skin collimation have potential for use in patient electron beam treatment planning. However, the small distortion in images with skin collimation makes them unsuitable for clinical use.