Treatment planning dose accuracy improvement in the presence of dental implants

被引:8
作者
Parenica, Holly M. [1 ]
Ford, John R. [2 ]
Mavroidis, Panayiotis [3 ]
Li, Ying [1 ]
Papanikolaou, Nikos [1 ]
Stathakis, Sotirios [1 ]
机构
[1] Univ Texas Hlth Sci Ctr San Antonio, Sch Med, Dept Radiat Oncol, San Antonio, TX 78229 USA
[2] Texas A&M Univ, Dwight Look Coll Engn, Dept Nucl Engn, College Stn, TX 77843 USA
[3] Univ N Carolina, Sch Med, Dept Radiat Oncol, Chapel Hill, NC 27599 USA
关键词
Metal implants; Dose calculation algorithms; Monte Carlo; Collapsed cone convolution superposition; METAL ARTIFACTS; NECK IMRT; HEAD; IMPACT;
D O I
10.1016/j.meddos.2018.04.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Streaking artifacts in computed tomography (CT) scans caused by metallic dental implants (MDIs) can lead to inaccuracies in dose calculations. This study quantifies and compares the effect of MDIs on dose distributions using the collapsed cone convolution superposition (CCCS) and Monte Carlo (MC) algorithms, with and without correcting for the density of the MDIs. Ion chamber measurements were taken to test the ability of the algorithms in Pinnacle(3) and Monaco to calculate dose near high-Z materials. Nine previously treated patients with head and neck cancer were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient, a plan was optimized and calculated using the Pinnacle(3) treatment planning system (TPS). Two dose calculations were performed for each patient: one with overridden densities of the MDI and CT artifacts and one without overridden densities of the MDI and CT artifacts. The plans were then exported to the Monaco TPS and recalculated for the same number of monitor units (MUs) using its MC dose calculation algorithm. The changes in dose to the planning target volume (PTV) and surrounding healthy tissues were examined between all the plans using VelocityAl. For the ion chamber measurements, when correct density information was used, Monaco was within 3% of the measured values, whereas the doses calculated in Pinnacle(3) varied up to 7%. The CCCS algorithm in Pinnacle(3) calculated only a significant decrease in PTV coverage for 1 patient when the densities were overridden. The MC algorithm in Monaco was able to calculate a significant change in PTV coverage for five of the patients when the density was overridden. Additionally, when healthy tissues affected by streaking artifacts were assigned the correct density, cumulative (from all the fractions) point doses increased up to 46.2 Gy. Not properly accounting for MDIs can impact both the high-dose regions (PTVs) and surrounding healthy tissues. This study demonstrates that if MDIs and the artifacts are not appropriately accounted for by contouring and assigning to them the correct density, there is a potential risk of compromising the quality of the plan regarding PTV coverage and dose to healthy tissues. (C) 2018 American Association of Medical Dosimetrists. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:159 / 166
页数:8
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