title: Influence of lipiodol agent on proton beam range in radiotherapy planning using computed tomography for hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the influence of lipiodol on the proton beam range, which has not yet been determined.
  
  
  METHODS
  Two computed tomography (CT) data sets were obtained with a T25-flask containing lipiodol and water that was placed above a water phantom. The plan with the lipiodol CT images was performed, and then a verification plan was applied to the water CT images. The actual proton beam ranges in the lipiodol and water were measured under same conditions, and we compared the calculated proton beam range in the treatment planning system with measured values.
  
  
  RESULTS
  The calculated distal range in the treatment planning system was 12 cm in water, which was 3.87 cm longer than that in lipiodol (8.13 cm). In contrast, the measured distal range was 12 +/- 0.01 cm in water, which was 0.21 +/- 0.01 cm longer than that of lipiodol (11.78 +/- 0.01 cm). A 3.65 +/- 0.01-cm range shift was found in the calculated range compared with the measured range. For 10 hepatocellular carcinoma patients, the distal range in the verification plan with the corrected CT images in which the Hounsfield unit (HU) value of lipiodolized lesion was replaced with the average HU value of the surrounding tissue was 0.61 +/- 0.26 cm (range, 0.26-0.99) longer than that in the plan with uncorrected CT images.
  
  
  CONCLUSIONS
  It could be relevant for the purposes of range calculation of proton beams in the treatment planning system that the HU value of a lipiodolized lesion is replaced by the average HU value of the surrounding normal tissue.
authors.affiliation: Proton Therapy Center, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
authors.forename: Dongho
authors.initials: D
authors.lastname: Shin
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Sung Yong
authors.initials: SY
authors.lastname: Park
authors.forename: Jungwon
authors.initials: J
authors.lastname: Kwak
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.forename: Myonggeun
authors.initials: M
authors.lastname: Yoon
authors.forename: Se Byeong
authors.initials: SB
authors.lastname: Lee
authors.forename: Soah
authors.initials: S
authors.lastname: Park
authors.forename: Kyung Hwan
authors.initials: KH
authors.lastname: Shin
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.forename: Kwan Ho
authors.initials: KH
authors.lastname: Cho
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002138:Calibration; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D003287:Contrast Media / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000494:pharmacology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011522:Protons; D011829:Radiation Dosage; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014867:Water
chemical_list: D003287:Contrast Media; D011522:Protons; D014867:Water; D007459:Iodized Oil