Improving accuracy of electron density measurement in the presence of metallic implants using orthovoltage computed tomography

The goal of this study was to evaluate the improvement in electron density measurement and metal artifact reduction using orthovoltage computed tomography (OVCT) imaging compared with conventional kilovoltage CT (KVCT). For this study, a bench-top system was constructed with adjustable x-ray tube voltage up to 320 kVp. A commercial tissue-characterization phantom loaded with inserts of various human tissue substitutes was imaged using 125 kVp (KVCT) and 320 kVp (OVCT) x rays. Stoichiometric calibration was performed for both KVCT and OVCT imaging using the Schneider method. The metal inserts - titanium rods and aluminum rods - were used to study the impact of metal artifacts on the electron-density measurements both inside and outside the metal inserts. It was found that the relationships between Hounsfield units and relative electron densities (to water) were more predictable for OVCT than KVCT. Unlike KVCT, the stoichiometric calibration for OVCT was insensitive to the use of tissue substitutes for direct electron density calibration. OVCT was found to significantly reduce metal streak artifacts. Errors in electron-density measurements within uniform tissue substitutes were reduced from 42% (maximum) and 18% (root-mean-square) in KVCT to 12% and 2% in OVCT, respectively. Improvements were also observed inside the metal implants. For the detectors optimized for KVCT, the imaging dose is almost doubled for OVCT for the image quality comparable to KVCT. OVCT may be a good option for high-precision radiotherapy treatment planning, especially for patients with metal implants and especially for charged particle therapy, such as proton therapy.