Abstract
The dosimetric effect of artefacts caused by metal hip prostheses in computed tomography imaging is most commonly encountered in the planning of prostate cancer treatment. In this study, a phantom, containing a metal with high atomic number, was prepared for intensity-modulated radiotherapy (IMRT) treatment plans to be used in quality assurance (QA) procedures. Two sets of image files, one without metal artefact correction (ORG) and another with MAR correction (MAR+), were sent to the treatment planning system. In this study, 12 IMRT treatment plans with different fields and segment numbers were calculated. The normal tissue complication probability (NTCP) values of imaginary organs at risk (OARs), such as the rectum and bladder, were investigated, as was the difference in dose maps for ORG and MAR+ derived by calculating gamma passing rates (GPRs). The MatriXX was used for the gamma evaluation of patient-specific IMRT QA measurements. The gamma evaluation was repeated, based on the measurements using an EBT3 gafchromic film, for the plan showing the lowest GPR. The mean relative difference in NTCP values between the two sets of image files was found to be 2.5, 2.1 and 1.4 for the rectum; and 5.33, 6.80 and 9.82 for the bladder, for the investigated 5-, 7- and 9-field beam arrangements, respectively. The relative differences and the standard deviations in GPRs for the standard and metal-containing phantoms were calculated for the MAR+ and ORG sets. The maximum difference found was 7.69% ± 0.88 for the 9-field beam arrangement calculated without metal artefact correction. In the IMRT QA procedures for prostate patients with hip prostheses, the application of a metal-containing phantom that is both easy and inexpensive to prepare, is considered to be a useful method for examining any dose changes involved in introducing a hip prosthesis. Therefore, it is recommended for use in clinics that do not have MAR correction algorithms.
Similar content being viewed by others
References
Ade N, du Plessis FCP (2017a) Dose comparison between Gafchromic film, XiO and Monaco treatment planning systems in a novel pelvic phantom that contains a titanium hip prosthesis. J Appl Clin Med Phys 18:162–173
Ade N, du Plessis FCP (2017b) Measurement of the influence of titanium hip prosthesis on therapeutic electron beam dose distributions in a novel pelvic phantom. Phys Med 42:99–107
Ade N, du Plessis FCP (2018) Monaco and film dosimetry of 3D CRT, IMRT and VMAT cases in a realistic pelvic prosthetic phantom. Radiat Phys Chem 145:50–57
Ade N, Oderinde OM, du Plessis FCP (2018) Monte Carlo dose in a prosthesis phantom based on exact geometry vs streak artefact contaminated CT data as benchmarked against Gafchromic film measurements. Phys Med 54:94–102
Baskar R, Lee KA, Yeo R, Yeoh KW (2012) Cancer and radiation therapy: current advances and future directions. Int J Med Sci 9(3):193–199
Bayouth JE, Wendt D, Morrill SM (2003) MLC quality assurance technique for IMRT applications. Med Phys 30:743–750
Buffard E, Gschwind R, Makovicka L, David C (2006) Monte Carlo calculations of the impact of a hip prosthesis on the dose distribution. Nucl Instrum Meth B 251(1):9–18
Burman C, Kutcher GJ, Emami B, Goitein M (1991) Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys 21(1):123–135
Connell PP, Hellman S (2009) Advances in radiotherapy and implications for the next century: a historical perspective. Cancer Res 69:383–392
Coolens C, Childs PJ (2003) Calibration of CT Hounsfield units for radiotherapy treatment planning of patients with metallic hip prostheses: the use of the extended CT-scale. Phys Med Biol 48(11):1591–1603
Ding GX, Yu CW (2001) A study on beams passing through hip prosthesis for pelvic radiation treatment. Int J Radiat Oncol Biol Phys 51:1167–1175
Dutreix A (1984) When and how can we improve precision in radiotherapy? Radiother Oncol 2:275–292
Eng TY (2000) Dose attenuation through a titanium alloy hip prosthesis. Med Dosim 25:7–8
Erlanson M, Franzén L (1991) Planning of radiotherapy for patients with hip prosthesis. Int J Radiat Oncol Biol Phys 20:1093–1098
Fattahi S, Ostapiak OZ (2012) An opposed matched field IMRT technique for prostate cancer patients with bilateral prosthetic hips. J Appl Clin Med Phys 13:44–57
Giantsoudi D, De Man B, Verburg J, Trofimov A, Jin Y, Wang G, Gjesteby L, Paganetti H (2017) Metal artifacts in computed tomography for radiation therapy planning: dosimetric effects and impact of metal artifact reduction. Phys Med Biol 62(8):R49–R80
Huang JY, Kerns JR, Nute JL, Liu X, Balter PA, Stingo FC, Followill DS, Mirkovic D, Howell RM, Kry SF (2015) An evaluation of three commercially available metal artifact reduction methods for CT imaging. Phys Med Biol 60(3):1047–1067
Huet C, Moignier C, Fontaine J, Clairand I (2014) Characterization of the gafchromic EBT3 films for dose distribution measurements in stereotactic radiotherapy. Rad Meas 71:364–368
IAEA (International Atomic Energy Agency) (2004) Commissioning and quality assurance of computerized planning systems for radiation treatment of cancer. Technical Reports Series No. 430, Vienna
ICRU (International Commission on Radiation Units and Measurements) (1976) Determination of absorbed dose in a patient irradiated by beams of X or gamma rays in radiotherapy procedures, Rep. 24. ICRU, Bethesda
Keall PJ, Siebers JV, Jeraj R, Mohan R (2003) Radiotherapy dose calculations in the presence of hip prostheses. Med Dosim 28(2):107–112
Kim Y, Tome WA (2007) On the radiobiological impact of metal artifacts in head-and-neck IMRT in terms of tumor control probability (TCP) and normal tissue complication probability (NTCP). Med Biol Eng Comput 45:1045–1051
Li H, Noel C, Chen H, Harold Li H, Low D, Moore K, Klahr P, Michalski J, Gay HA, Thorstad W, Mutic S (2012) Clinical evaluation of a commercial orthopedic metal artifact reduction tool for CT simulations in radiation therapy. Med Phys 39(12):7507–7517
Li T, Wu Q, Yang Y, Rodrigues A, Yin FF, Jackie WuQ (2015) Quality assurance for online adapted treatment plans: benchmarking and delivery monitoring simulation. Med Phys 42(1):381–390
Lyman JT (1985) Complication probability as assessed from dose-volume histograms. Radiat Res 104:13–19
Mesbahi A, Nejad FS (2007) Dose attenuation effect of hip prostheses in a 9-MV photon beam: commercial treatment planning system versus Monte Carlo calculations. Radiat Med 25:529–535
Mijnheer BJ (1987) What degree of accuracy is required and can be achieved in photon and neutron therapy? Radiother Oncol 18:237–252
Ojala J, Kapanen M, Sipilä P, Hyödynmaa S, Pitkänen M (2014) The accuracy of Acuros XB algorithm for radiation beams traversing a metallic hip implant—comparison with measurements and Monte Carlo calculations. J Appl Clin Med Phys 15(5):162–176
Rabelo KA, Cavalcanti YW, de Oliveira Pinto MG, de Melo DP (2017) Quantitative assessment of image artifacts from root filling materials on CBCT scans made using several exposure parameters. Imaging Sci Dent 47:189–197
Reft C, Alecu R, Das IJ, Gerbi BJ, Keall P, Lief E, Mijnheer BJ, Papanikolaou N, Sibata C, Van Dyk J (2003) Dosimetric considerations for patients with HIP prostheses undergoing pelvic irradiation. Report of the AAPM radiation therapy committee task group 63. Med Phys 30(6):1162–1182
Roopashri G, Baig M (2013) Current advances in radiotherapy of head and neck malignancies. J Int Oral Health 5(6):119–123
Schwahofer A (2015) The application of metal artifact reduction (MAR) in CT scans for radiation oncology by monoenergetic extrapolation with a DECT scanner. Z Med Phys 25:314–325
Shen ZL, Xia P, Klahr P, Djemil T (2015) Dosimetric impact of orthopedic metal artifact reduction (O-MAR) on spine SBRT patients. J Appl Clin Med Phys 16(5):106–116
Spadea MF, Verburg J, Baroni G, Seco J (2013) Dosimetric assessment of a novel metal artifact reduction method in CT images. J Appl Clin Med Phys 14(1):4027
Spezi E, Palleri F, Angelini AL, Ferri A, Baruffaldi F (2007) Characterization of materials for prosthetic implants using the BEAMnrc Monte Carlo code. J Phys Conf Ser 74(1):021016
Su A, Reft C, Rash C, Price J, Jane AB (2005) A case study of radiotherapy planning for a bilateral metal hip prosthesis prostate cancer patient. Med Dosim 30(3):169–175
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Inal, A., Sarpün, I.H. Dosimetric evaluation of phantoms including metal objects with high atomic number for use in intensity modulated radiation therapy. Radiat Environ Biophys 59, 503–510 (2020). https://doi.org/10.1007/s00411-020-00851-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00411-020-00851-0