Evaluation and temporal evolution of image quality and its dosimetric effect on the dose distributions calculated on megavoltage CT images from tomotherapy unit

Abstract

Over a period of five years the temporal evolution of the image quality parameters and the linearity of the Hounsfield units (HU) of megavoltage studies (MVCT) were analyzed as well as the influence of the actions of the field service engineer. Furthermore the dosimetric impact of HU variation as a result of such actions was studied in three clinical cases (prostate, head and neck, and lung). MVCT images showed an appropriate image quality for image-guided radiotherapy and adaptive radiation therapy despite its lower contrast to noise ratio in comparison to the kilovoltage studies. Because of temporal stability of the linearity between HU and mass density, MVCT studies were appropriate for dose calculation especially to avoid artifacts due to high density metallic structures. Target changes had the largest effect on the imaging parameters analyzed. Variations around 30 and 50 HU for water and bone, respectively, led to a dosimetric error of 1% for the studied locations; while discrepancies about 6% were found as a result of higher HU changes.