Evaluating the effects of variation in CT scanning parameters on the image quality and Hounsfield units for optimization of dose in radiotherapy treatment planning: A semi-anthropomorphic thorax phantom study

Aim: The diagnosis accuracy of computed tomography (CT) systems and the reliability of calculated Hounsfield Units (HUs) are critical in tumor detection and cancer patients' treatment planning. This study evaluated the effects of scan parameters (Kilovoltage peak or kVp, milli-Ampere-second or mAS reconstruction kernels and algorithms, reconstruction field of view, and slice thickness) on image quality, HUs, and the calculated dose in the treatment planning system (TPS). Materials and Methods: A quality dose verification phantom was scanned several times by a 16-slice Siemens CT scanner. The DOSIsoft ISO gray TPS was applied for dose calculations. The SPSS.24 software was used to analyze the results and the P-value <0.05 was considered significant. Results: Reconstruction kernels and algorithms significantly affected noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The noise increased and CNR decreased by raising the sharpness of reconstruction kernels. SNR and CNR had considerable increments at iterative reconstruction compared with the filtered back-projection algorithm. The noise decreased by raising mAS in soft tissues. Also, KVp had a significant effect on HUs. TPS--calculated dose variations were less than 2% for mediastinum and backbone and less than 8% for rib. Conclusions: Although HU variation depends on image acquisition parameters across a clinically feasible range, its dosimetric impact on the calculated dose in TPS can be neglected. Hence, it can be concluded that the optimized values of scan parameters can be applied to obtain the maximum diagnostic accuracy and calculate HUs more precisely without affecting the calculated dose in the treatment planning of cancer patients.