The impact of CT scan energy on range calculation in proton therapy planning.

The purpose of this study was to investigate the impact of tube potential (kVp) on the CT number (HU) to proton stopping power ratio (PSPR) conversion. The range and dosimetric change introduced by a mismatch in kVp used for the CT scan and the HU to PSPR table, based on a specific kVp, used to calculate dose are analyzed. Three HU to PSPR curves, corresponding to three kVp settings on the CT scanner, were created. A treatment plan was created for a single beam in a water phantom passing through a wedge-shaped bone heterogeneity. The dose was recalculated by changing only the HU to PSPR table used in the dose calculation. The change in the position of the distal 90% isodose line was recorded as a function of heterogeneity thickness along the beam path. The dosimetric impact of a mismatch in kVp between the CT and the HU to PSPR table was investigated by repeating this procedure for five clinical plans comparing DVH data and dose difference distributions. The HU to PSPR tables diverge for CT numbers greater than 200 HU. In the phantom plan, the divergence of the tables resulted in a difference in range of 1.6 mm per cm of bone in the beam path, for the HU used. For the clinical plans, the dosimetric effect of a kVp mismatch depends on the amount of bone in the beam path and the proximity of OARs to the distal range of the planned beams. A mismatch in kVp between the CT and the HU to PSPR table can introduce inaccuracy in the proton beam range. For dense bone, the measured range difference was approximately 1.6 mm per cm of bone along the beam path. However, the clinical cases analyzed showed a range change of 1 mm or less. Caution is merited when such a mismatch may occur.