The use of megavoltage cone-beam CT to complement CT for target definition in pelvic radiotherapy in the presence of hip replacement

In Europe and the USA combined, over half a million people had a hip joint replaced in 2005, contributing to the increasing number of radiotherapy patients with metallic hip prostheses. The treatment plan for external beam radiation therapy is based on the delineation of the anatomy in the planning CT scan. When implanted objects of high atomic number (Z) material are present, however, severe image artefacts are generated in conventional CT, strongly hindering the ability to delineate some organs. This is particularly the case for the planning of prostate patients with hip prostheses. This short communication presents the use of a new imaging modality, megavoltage cone-beam CT, to complement the regular CT for target definition of prostate cancer treatment of patients with hip replacements.