Impact of dual-layer spectral CT-derived stopping power ratio on single-energy CT-based carbon-ion treatment planning for thoracic cancer
8 affiliations
- 1Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- 2Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Republic of Korea
- 3Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- 4Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- 5Project Group of the Gijang Heavy Ion Medical Accelerator, Seoul National University Hospital, Seoul, Republic of Korea
- 6Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
- 7Department of Radiology, National Jewish Health, Denver, Colorado, United States of America
- 8Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Abstract
Purpose: To evaluate the impact of stopping-power ratio (SPR) predictions derived from dual-layer detector-based spectral CT (DLCT) on conventional single-energy CT (SECT)-based carbon-ion treatment planning for thoracic cancer. Methods: Twenty patients with thoracic cancer who underwent non-contrast DLCT were retrospectively included. DLCT-based SPR images were generated from effective atomic number and relative electron density maps using the Bethe equation. SECT-based SPR was derived using a Hounsfield unit look-up table generated via stoichiometric calibration of a commercial electron density phantom. Using the same phantom, a phantom-based prediction assessment was performed by comparing SECT- and DLCT-based SPR predictions with theoretical SPR values for the inserts. For patient analysis, normal-tissue SPR values derived from SECT and DLCT were compared. Carbon-ion treatment plans were first generated based on SECT images and then recalculated using DLCT-derived SPR images. Range differences in the beam’s-eye view and dose–volume histogram parameters for the planning target volume and organs at risk were evaluated. Results: In the phantom-based assessment, the root-mean-square error relative to the theoretical SPR was 5.57% for SECT and 2.83% for DLCT. In patient images, mean SPR differences between SECT and DLCT were 3.62% for the lungs, 1.93% for the esophagus, 0.04% for the heart, 0.93% for the spinal cord, and 1.53% for the ribs. Across the patient cohort, the mean recalculated range difference was 0.71 ± 0.89 mm, corresponding to a relative difference of 0.60 ± 0.67%. No statistically significant differences were observed in target dose metrics, whereas selected organ-at-risk metrics showed statistically significant differences between SECT-based plans and DLCT-based recalculations. Conclusion: DLCT-derived SPR prediction showed better agreement with theoretical phantom SPR values in the phantom-based prediction assessment and produced tissue-dependent SPR differences in thoracic patient images compared with conventional SECT-based prediction. Recalculation on DLCT-derived SPR maps resulted in modest but systematic range differences and limited changes in selected dose metrics. These results may inform the implementation and future independent validation of patient-specific DLCT-based SPR workflows in carbon-ion treatment planning for thoracic cancer.
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BibTeX
@article{yoon2026impact,
title = {{Impact of dual-layer spectral CT-derived stopping power ratio on single-energy CT-based carbon-ion treatment planning for thoracic cancer}},
author = {Euntaek Yoon and Sung Hyun Lee and Hyeongmin Jin and Tae Ho Jang and Sungjin Yoon and Hyung Jin Choun and Soon Ho Yoon and Jin Mo Goo and Jong Min Park},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358184},
url = {https://doi.org/10.1371/journal.pone.0358184},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of dual-layer spectral CT-derived stopping power ratio on single-energy CT-based carbon-ion treatment planning for thoracic cancer
AU - Euntaek Yoon
AU - Sung Hyun Lee
AU - Hyeongmin Jin
AU - Tae Ho Jang
AU - Sungjin Yoon
AU - Hyung Jin Choun
AU - Soon Ho Yoon
AU - Jin Mo Goo
AU - Jong Min Park
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0358184
UR - https://doi.org/10.1371/journal.pone.0358184
AB - Purpose: To evaluate the impact of stopping-power ratio (SPR) predictions derived from dual-layer detector-based spectral CT (DLCT) on conventional single-energy CT (SECT)-based carbon-ion treatment planning for thoracic cancer. Methods: Twenty patients with thoracic cancer who underwent non-contrast DLCT were retrospectively included. DLCT-based SPR images were generated from effective atomic number and relative electron density maps using the Bethe equation. SECT-based SPR was derived using a Hounsfield unit look-up table generated via stoichiometric calibration of a commercial electron density phantom. Using the same phantom, a phantom-based prediction assessment was performed by comparing SECT- and DLCT-based SPR predictions with theoretical SPR values for the inserts. For patient analysis, normal-tissue SPR values derived from SECT and DLCT were compared. Carbon-ion treatment plans were first generated based on SECT images and then recalculated using DLCT-derived SPR images. Range differences in the beam’s-eye view and dose–volume histogram parameters for the planning target volume and organs at risk were evaluated. Results: In the phantom-based assessment, the root-mean-square error relative to the theoretical SPR was 5.57% for SECT and 2.83% for DLCT. In patient images, mean SPR differences between SECT and DLCT were 3.62% for the lungs, 1.93% for the esophagus, 0.04% for the heart, 0.93% for the spinal cord, and 1.53% for the ribs. Across the patient cohort, the mean recalculated range difference was 0.71 ± 0.89 mm, corresponding to a relative difference of 0.60 ± 0.67%. No statistically significant differences were observed in target dose metrics, whereas selected organ-at-risk metrics showed statistically significant differences between SECT-based plans and DLCT-based recalculations. Conclusion: DLCT-derived SPR prediction showed better agreement with theoretical phantom SPR values in the phantom-based prediction assessment and produced tissue-dependent SPR differences in thoracic patient images compared with conventional SECT-based prediction. Recalculation on DLCT-derived SPR maps resulted in modest but systematic range differences and limited changes in selected dose metrics. These results may inform the implementation and future independent validation of patient-specific DLCT-based SPR workflows in carbon-ion treatment planning for thoracic cancer.
SN - 1932-6203
ER -