Feasibility study of using triple-energy CT images for improving stopping power estimation

The planning accuracy of charged particle therapy (CPT) is subject to the accuracy of stopping power (SP) estimation. In this study, we propose a method of deriving a pseudo-triple-energy CT (pTECT) that can be achievable in the existing dual-energy CT (DECT) systems for better SP estimation. In order to remove the direct effect of errors in CT values, relative CT values according to three scanning voltage settings were used. CT values of each tissue substitute phantom were measured to show the non-linearity of the values thereby suggesting the absolute difference and ratio of CT values as parameters for SP estimation. Electron density, effective atomic number (EAN), mean excitation energy and SP were calculated based on these parameters. Two of conventional methods were implemented and compared to the proposed pTECT method in terms of residuals, absolute error and root-mean-square-error (RMSE). The proposed method outperformed the comparison methods in every evaluation metrics. Especially, the estimation error for EAN and mean excitation using pTECT were converging to zero. In this proof-of-concept study, we showed the feasibility of using three CT values for accurate SP estimation. Our suggested pTECT method indicates potential clinical utility of spectral CT imaging for CPT planning.(c) 2022 Korean Nuclear Society, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).