The uncertainties in radiation therapy planning
DOI:
https://doi.org/10.26641/2307-0404.2026.1.356906Keywords:
radiotherapy, medical images, optical density, absorbed dose, uncertaintiesAbstract
The quality of radiation therapy has significantly improved due to the introduction of new irradiation sources, advanced delivery techniques, and modern three-dimensional treatment planning. However, the level of radiation-induced damage remains considerable, necessitating an assessment of the accuracy of tools responsible for image generation and dose calculation. The aim of the study was to identify potential uncertainties arising from the use of the TOSHIBA Asteion Super 4 computed tomography software and the planning systems of the Elekta Synergy linear accelerator (Elekta Limited), as well as to determine approaches for reducing these uncertainties. Twenty-eight patient radiotherapy plans carried out on the Elekta Synergy accelerator within the past four years were subjected to analysis. To evaluate image parameters, computed tomography data with a slice reconstruction thickness of 1.5 mm processed using the eFilm software were analysed. Pixel size, the number of pixels within a selected region, area, and optical density of various image segments were measured. Dose-planning uncertainties were estimated in the Monaco Treatment Planning System software based on absorbed-dose values in regions with minimal optical density inside the irradiation target contours, in the black-background cavities within the object, and outside the external body contour at various distances. The analysis revealed incorrect determination of image geometric parameters by eFilm, with an error of 8-15%. Optical-density values in the black background ranged from –1000 HU near the object boundary to -834 HU at greater distances. Significant variations in absorbed dose were observed in low-density regions: under identical conditions, dose values ranged from 0.0 Gy to 15.4 Gy. At a distance of 4 mm from the outer contour, an optical density of -1001 HU corresponded to a dose of 5.9 Gy, increasing with proximity to the contour. These findings indicate that errors in DICOM-image formation and dose calculation may introduce substantial uncertainties affecting treatment-planning accuracy and therapeutic outcomes. Improving computed tomography (CT) image-processing software and radiotherapy planning systems is considered a promising approach to reducing such uncertainties.
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