Hounsfield units variations: impact on CT-density based conversion tables and their effects on dose distribution.

Purpose: Determination of dose error margins in radiation therapy planning due to variations in Hounsfield Units (HU) values dependent on the use of different CT scanning protocols.

Patients And Methods: Based on a series of different CT scanning protocols used in clinical practice, conversion tables for radiation dose calculations were generated and subsequently tested on a phantom. These tables were then used to recalculate the radiation therapy plans of 28 real patients after an incorrect scanning protocol had inadvertently been used for these patients.

Results: Different CT parameter settings resulted in errors of HU values of up to 2.6% for densities of <1.1 g/cm(3), but up to 25.6% for densities of >1.1 g/cm(3). The largest errors were associated with changes in the tube voltage. Tests on a virtual water phantom with layers of variable thickness and density revealed a sawtooth-shaped curve for the increase of dose differences from 0.3 to 0.6% and 1.5% at layer thicknesses of 1, 3, and 7 cm, respectively. Use of a beam hardening filter resulted in a reference dose difference of 0.6% in response to a density change of 5%. The recalculation of data from 28 patients who received radiation therapy to the head revealed an overdose of 1.3 ± 0.4% to the bone and 0.7 ± 0.1% to brain tissue. On average, therefore, one monitor unit (range 0-3 MU) per 100 MU more than the correct dose had been given.

Conclusion: Use of different CT scanning protocols leads to variations of up to 20% in the HU values. This can result in a mean systematic dose error of 1.5%. Specific conversion tables and automatic CT scanning protocol recognition could reduce dose errors of these types.