CT Extended Hounsfield Unit Range in Radiotherapy Treatment Planning for Patients with Implantable Medical Devices

Radiotherapy (RT) treatment planning is based on computed tomography (CT) images and traditionally uses the conventional Hounsfield unit (CHU) range. This HU range is suited for human tissue but inappropriate for metallic materials. To guarantee safety of patient carrying implants precise HU quantification is beneficial for accurate dose calculations in planning software. Some modern CT systems offer an extended HU range (EHU). This study focuses the suitability of these two HU ranges for the quantification of metallic components of active implantable medical devices (AIMD). CT acquisitions of various metallic and non-metallic materials aligned in a water phantom were investigated. From our acquisitions we calculated that materials with mass-density ρ > 3.0 g/cm³ cannot be represented in the CHU range. For these materials the EHU range could be used for accurate HU quantification. Since the EHU range does not effect the HU values for materials ρ < 3.0 g/cm³, it can be used as a standard for RT treatment planning for patient with and without implants.