RESUMO
Computerized tomography (CT) is used routinely in evaluating radiation therapy isodose plans. With the introduction of 3D algorithms such as the voxel raytrace, which determines inhomogeneity corrections from actual CT Hounsfield numbers, caution must be used when evaluating isodose calculations. Artifacts from contrast media and dental work, radiopaque markers placed by the treatment planner, and changing bowel and rectal air patterns all have the potential to introduce error into the calculation due to inaccurate assessment of high or low density. Radiopaque makers such as x-spot BB's or solder wire are placed externally on the patient. Barium contrast media introduced at the time of simulation may be necessary to visualize specific anatomical structures on the CT images. While these localization and visualization tools may be necessary, it is important to understand the effects they may introduce in the planning process. Other problems encountered are patient specific and out of the control of the treatment planner. These include high- and low-density streaking caused by dental work, which produce computational errors due to overestimation, and small bowel and rectal air, the patterns of which change on a daily basis and may result in underestimation of structure density. It is important for each treatment planner to have an understanding of how this potentially tainted CT information may be applied in dose calculations and the possible effects they may have. At our institution, the voxel raytrace calculation is automatically forced any time couch angle is introduced. Errors in the calculation from the above mentioned situations may be introduced if a heterogeneity correction is applied. Examples of potential calculation errors and the magnitude of each will be discussed. The methods used to minimize these errors and the possible solutions will also be evaluated.
