CT number calibration audit in photon radiation therapy

Inadequate computed tomography (CT) number calibration curves affect dose calculation accuracy. Although CT number calibration curves registered in treatment planning systems (TPSs) should be consistent with human tissues, it is unclear whether adequate CT number calibration is performed because CT number calibration curves have not been assessed for various types of CT number calibration phantoms and TPSs.

The purpose of this study was to investigate CT number calibration curves for mass density (ρ) and relative electron density (ρ_e ).

A CT number calibration audit phantom was sent to 24 Japanese photon therapy institutes from the evaluating institute and scanned using their individual clinical CT scan protocols. The CT images of the audit phantom and institute-specific CT number calibration curves were submitted to the evaluating institute for analyzing the calibration curves registered in the TPSs at the participating institutes. The institute-specific CT number calibration curves were created using commercial phantom (Gammex, Gammex Inc., Middleton, WI, USA) or CIRS phantom (Computerized Imaging Reference Systems, Inc., Norfolk, VA, USA)). At the evaluating institute, theoretical CT number calibration curves were created using a stoichiometric CT number calibration method based on the CT image, and the institute-specific CT number calibration curves were compared with the theoretical calibration curve. Differences in ρ and ρ_e over the multiple points on the curve (Δρ_m and Δρ_e,m , respectively) were calculated for each CT number, categorized for each phantom vendor and TPS, and evaluated for three tissue types: lung, soft tissues, and bones. In particular, the CT-ρ calibration curves for Tomotherapy TPSs (ACCURAY, Sunnyvale, CA, USA) were categorized separately from the Gammex CT-ρ calibration curves because the available tissue-equivalent materials (TEMs) were limited by the manufacturer recommendations. In addition, the differences in ρ and ρ_e for the specific TEMs (Δρ_TEM and Δρ_e,TEM , respectively) were calculated by subtracting the ρ or ρ_e of the TEMs from the theoretical CT-ρ or CT-ρ_e calibration curve.

The mean ± standard deviation (SD) of Δρ_m and Δρ_e,m for the Gammex phantom were -1.1 ± 1.2 g/cm³ and -0.2 ± 1.1, -0.3 ± 0.9 g/cm³ and 0.8 ± 1.3, and -0.9 ± 1.3 g/cm³ and 1.0 ± 1.5 for lung, soft tissues, and bones, respectively. The mean ± SD of Δρ_m and Δρ_e,m for the CIRS phantom were 0.3 ± 0.8 g/cm³ and 0.9 ± 0.9, 0.6 ± 0.6 g/cm³ and 1.4 ± 0.8, and 0.2 ± 0.5 g/cm³ and 1.6 ± 0.5 for lung, soft tissues, and bones, respectively. The mean ± SD of Δρ_m for Tomotherapy TPSs was 2.1 ± 1.4 g/cm³ for soft tissues, which is larger than those for other TPSs. The mean ± SD of Δρ_e,TEM for the Gammex brain phantom (BRN-SR2) was -1.8 ± 0.4, implying that the tissue equivalency of the BRN-SR2 plug was slightly inferior to that of other plugs.

Latent deviations between human tissues and TEMs were found by comparing the CT number calibration curves of the various institutes.