Combined single- and dual-energy CT workflow for dose calculation in radiotherapy

Background and purpose: Dual-energy computed tomography (DECT) is increasingly used in radiotherapy delineation due to its enhanced soft tissue contrast. DECT also supports direct dose calculation. However, as most current DECT scanners allow for use in only certain body regions, conventional single...

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Main Authors: Hella Sand, Jens Edmund, Ane Appelt, Patrick Wohlfahrt, Vicki Trier Taasti, Laurids Østergaard Poulsen, Jimmi Søndergaard, Martin Skovmos Nielsen
Format: Article
Language:English
Published: Medical Journals Sweden 2025-08-01
Series:Acta Oncologica
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Online Access:https://medicaljournalssweden.se/actaoncologica/article/view/43827
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author Hella Sand
Jens Edmund
Ane Appelt
Patrick Wohlfahrt
Vicki Trier Taasti
Laurids Østergaard Poulsen
Jimmi Søndergaard
Martin Skovmos Nielsen
author_facet Hella Sand
Jens Edmund
Ane Appelt
Patrick Wohlfahrt
Vicki Trier Taasti
Laurids Østergaard Poulsen
Jimmi Søndergaard
Martin Skovmos Nielsen
author_sort Hella Sand
collection DOAJ
description Background and purpose: Dual-energy computed tomography (DECT) is increasingly used in radiotherapy delineation due to its enhanced soft tissue contrast. DECT also supports direct dose calculation. However, as most current DECT scanners allow for use in only certain body regions, conventional single-energy computed tomography (SECT) is still needed for some patients. A safe clinical introduction of DECT thus requires a combined workflow. This study therefore investigates whether a unified Hounsfield look-up table (HLUT) can be applied across SECT and DECT reconstructions. Patient/material and methods: A Gammex Advanced Electron Density phantom containing tissue-equivalent inserts was scanned using SECT (70–140 kVp and Sn100–Sn140 kVp, Sn meaning tin-filtered) and dual-spiral DECT to identify matching HLUTs for three SECT methods, including a standard reconstruction (only 120 kVp; Method 1), and kVp-independent reconstructions providing mass density (MD; Method 2) or relative electron density (RED; Method 3). Dose agreement was subsequently tested on two anthropomorphic phantoms. For each SECT method, DECT reconstructions were compared through voxel-wise analysis of computed tomography (CT) numbers, and by performing dose calculations in three anatomical regions: head, thorax, and abdomen/pelvis. Results: Across all three SECT methods, DECT reconstructions with acceptable clinical CT number agreement were identified. Corresponding dose calculations between SECT- and DECT-based plans showed minimal differences. Interpretation: This phantom study demonstrates that a unified HLUT can be applied across SECT and DECT using standard 120 kVp, MD, or RED reconstructions. This approach may streamline clinical workflows and support a safe and practical transition to DECT-based treatment planning.
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spelling doaj-art-30f4f60dd5fc43c8a3a80bb18c485e822025-08-20T03:46:58ZengMedical Journals SwedenActa Oncologica1651-226X2025-08-016410.2340/1651-226X.2025.43827Combined single- and dual-energy CT workflow for dose calculation in radiotherapyHella Sand0https://orcid.org/0009-0004-4895-1080Jens Edmund1https://orcid.org/0000-0001-5831-6209Ane Appelt2https://orcid.org/0000-0003-2792-9218Patrick Wohlfahrt3https://orcid.org/0000-0002-2121-0934Vicki Trier Taasti 4https://orcid.org/0000-0002-4588-9769Laurids Østergaard Poulsen5https://orcid.org/0000-0002-0466-976XJimmi Søndergaard6https://orcid.org/0009-0005-2808-8993Martin Skovmos Nielsen7https://orcid.org/0000-0002-3955-7266Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkDepartment of Oncology, Radiotherapy Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, DenmarkLeeds Institute of Medical Research, University of Leeds, Leeds, UKSiemens Healthineers, Varian, Cancer Therapy Imaging, Forchheim, GermanyDanish Centre for Particle Therapy, Aarhus University / Aarhus University Hospital, Aarhus, DenmarkDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Oncology, Aalborg University Hospital, Aalborg, DenmarkDepartment of Oncology, Aalborg University Hospital, Aalborg, DenmarkDepartment of Medical Physics, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkBackground and purpose: Dual-energy computed tomography (DECT) is increasingly used in radiotherapy delineation due to its enhanced soft tissue contrast. DECT also supports direct dose calculation. However, as most current DECT scanners allow for use in only certain body regions, conventional single-energy computed tomography (SECT) is still needed for some patients. A safe clinical introduction of DECT thus requires a combined workflow. This study therefore investigates whether a unified Hounsfield look-up table (HLUT) can be applied across SECT and DECT reconstructions. Patient/material and methods: A Gammex Advanced Electron Density phantom containing tissue-equivalent inserts was scanned using SECT (70–140 kVp and Sn100–Sn140 kVp, Sn meaning tin-filtered) and dual-spiral DECT to identify matching HLUTs for three SECT methods, including a standard reconstruction (only 120 kVp; Method 1), and kVp-independent reconstructions providing mass density (MD; Method 2) or relative electron density (RED; Method 3). Dose agreement was subsequently tested on two anthropomorphic phantoms. For each SECT method, DECT reconstructions were compared through voxel-wise analysis of computed tomography (CT) numbers, and by performing dose calculations in three anatomical regions: head, thorax, and abdomen/pelvis. Results: Across all three SECT methods, DECT reconstructions with acceptable clinical CT number agreement were identified. Corresponding dose calculations between SECT- and DECT-based plans showed minimal differences. Interpretation: This phantom study demonstrates that a unified HLUT can be applied across SECT and DECT using standard 120 kVp, MD, or RED reconstructions. This approach may streamline clinical workflows and support a safe and practical transition to DECT-based treatment planning. https://medicaljournalssweden.se/actaoncologica/article/view/43827radiotherapy planningimagingcomputed tomographyphantomalgorithm
spellingShingle Hella Sand
Jens Edmund
Ane Appelt
Patrick Wohlfahrt
Vicki Trier Taasti
Laurids Østergaard Poulsen
Jimmi Søndergaard
Martin Skovmos Nielsen
Combined single- and dual-energy CT workflow for dose calculation in radiotherapy
Acta Oncologica
radiotherapy planning
imaging
computed tomography
phantom
algorithm
title Combined single- and dual-energy CT workflow for dose calculation in radiotherapy
title_full Combined single- and dual-energy CT workflow for dose calculation in radiotherapy
title_fullStr Combined single- and dual-energy CT workflow for dose calculation in radiotherapy
title_full_unstemmed Combined single- and dual-energy CT workflow for dose calculation in radiotherapy
title_short Combined single- and dual-energy CT workflow for dose calculation in radiotherapy
title_sort combined single and dual energy ct workflow for dose calculation in radiotherapy
topic radiotherapy planning
imaging
computed tomography
phantom
algorithm
url https://medicaljournalssweden.se/actaoncologica/article/view/43827
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