Potential of a Second-Generation Dual-Layer Spectral CT for Dose Calculation in Particle Therapy Treatment Planning

Abstract

In particle therapy treatment planning, dose calculation is conducted using patient-specific maps of tissue ion stopping power ratio (SPR) to predict beam ranges. Improving patient-specific SPR prediction is therefore essential for accurate dose calculation. In this study, we investigated the use of the Spectral CT 7500, a second-generation dual-layer spectral computed tomography (DLCT) system, as an alternative to conventional single-energy CT (SECT) for patient-specific SPR prediction. This dual-energy CT (DECT)-based method allows for the direct prediction of SPR from quantitative measurements of relative electron density and effective atomic number using the Bethe equation, whereas the conventional SECT-based method consists of indirect image data-based prediction through the conversion of calibrated CT numbers to SPR. The performance of the Spectral CT 7500 in particle therapy treatment planning was characterized by conducting a thorough analysis of its SPR prediction accuracy for both tissue-equivalent materials and common non-tissue implant materials. In both instances, DLCT was found to reduce uncertainty in SPR predictions compared to SECT. Mean deviations of 0.7% and 1.6% from measured SPR values were found for DLCT- and SECT-based predictions, respectively, in tissue-equivalent materials. Furthermore, end-to-end analyses of DLCT-based treatment planning were performed for proton, helium, and carbon ion therapies with anthropomorphic head and pelvic phantoms. 3D gamma analysis was performed with ionization chamber array measurements as the reference. DLCT-predicted dose distributions revealed higher passing rates compared to SECT-predicted dose distributions. In the DLCT-based treatment plans, measured distal-edge evaluation layers were within 1 mm of their predicted positions, demonstrating the accuracy of DLCT-based particle range prediction. This study demonstrated that the use of the Spectral CT 7500 in particle therapy treatment planning may lead to better agreement between planned and delivered dose compared to current clinical SECT systems.

Dual‐energy CT‐based stopping power prediction for dental materials in particle therapy

“…Finally, other non‐tissue implant materials in the body (e.g., spinal stabilization implants, hip prostheses, or silicone breast implants 53 ) may also benefit from using DECT‐based SPR prediction. For example, by using DECT, the SPR overestimation for PALACOS ® R + G bone cement (Heraeus, Hanau, Germany) was reduced from 50% to less than 10% 18 . Future work might investigate other non‐tissue implant materials in the human body using DECT imaging for particle therapy treatment planning.…”

“…Dental implant or restoration materials are composed of various materials such as cobalt-chrome, composites, glass-ceramic, lithium disilicate, titanium, and zirconium dioxide (Supplementary Table S1). focus on particle therapy treatment planning has been described in previous works [8][9][10]18 and is summarized in Section 2.2. This study is the first to comprehensively investigate a full spectrum of common dental materials.…”

“…[8][9][10][11] In various studies conducted with tissue surrogates or biological tissues as well as in patient analyses, DECT showed improved SPR prediction for particle therapy compared to SECT. 8,[12][13][14][15][16][17][18] Besides human tissue, the usage of DECT in particle therapy planning may also be advantageous for non-tissue implant materials. 12,18 For treating patients with dental implant and restoration materials, different avoidance strategies have been employed so far.…”

“…In various studies conducted with tissue surrogates or biological tissues as well as in patient analyses, DECT showed improved SPR prediction for particle therapy compared to SECT 8,12–18 . Besides human tissue, the usage of DECT in particle therapy planning may also be advantageous for non‐tissue implant materials 12,18 …”

“…8,[12][13][14][15][16][17][18] Besides human tissue, the usage of DECT in particle therapy planning may also be advantageous for non-tissue implant materials. 12,18 For treating patients with dental implant and restoration materials, different avoidance strategies have been employed so far. For example, non-ideal beam geometries have been applied to avoid beam directions intersecting with a dental material, or treatment volumes have been modified to exclude dental materials.…”