Dosimetric significance of manual density overrides in oropharyngeal cancer

Abstract

Kilovoltage computed tomography plays a crucial role in radiotherapy planning. However, the presence of high-density metallic objects can introduce streaking artifacts in CT scans, resulting in inaccurate dose calculations by the treatment planning software. Previous studies have explored manual density overrides and artifact reduction algorithms individually to enhance dose calculation accuracy, but their combined application on patient plans within a treatment planning system remains unexplored. This research aims to assess the necessity of manual density overrides when an artifact reduction algorithm is already employed to address dental artifacts in oropharyngeal cancer treatment plans. A total of 20 previously treated volumetric modulated arc therapy plans were collected, and manual density overrides were removed followed by plan recalculation. Dosimetric parameters were then compared between the original and modified plans. Statistical analysis revealed several dosimetric parameters for the planning target volume (PTV), clinical target volume (CTV), and oral cavity that exhibited statistically significant differences upon removing the manual density override. However, these differences were found to be small in absolute terms. No other organs evaluated demonstrated statistically significant differences in dose. The most significant disparity observed was an 8.26 cGy increase in mean dose to the CTV, which represents only 0.12% of the prescription dose. Based on these findings, it can be concluded that manual density overrides are likely unnecessary when an artifact reduction algorithm is employed in oropharyngeal cancer cases.