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      Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual‐energy CT

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          Abstract

          Over the past decade, spectral or dual‐energy CT has gained relevancy, especially in oncological radiology. Nonetheless, its use in the radiotherapy (RT) clinic remains limited. This review article aims to give an overview of the current state of spectral CT and to explore opportunities for applications in RT.

          In this article, three groups of benefits of spectral CT over conventional CT in RT are recognized. Firstly, spectral CT provides more information of physical properties of the body, which can improve dose calculation. Furthermore, it improves the visibility of tumors, for a wide variety of malignancies as well as organs‐at‐risk OARs, which could reduce treatment uncertainty. And finally, spectral CT provides quantitative physiological information, which can be used to personalize and quantify treatment.

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          Dual- and Multi-Energy CT: Principles, Technical Approaches, and Clinical Applications.

          Cynthia McCollough, Shuai Leng, Lifeng Yu … (2015)
          In x-ray computed tomography (CT), materials having different elemental compositions can be represented by identical pixel values on a CT image (ie, CT numbers), depending on the mass density of the material. Thus, the differentiation and classification of different tissue types and contrast agents can be extremely challenging. In dual-energy CT, an additional attenuation measurement is obtained with a second x-ray spectrum (ie, a second "energy"), allowing the differentiation of multiple materials. Alternatively, this allows quantification of the mass density of two or three materials in a mixture with known elemental composition. Recent advances in the use of energy-resolving, photon-counting detectors for CT imaging suggest the ability to acquire data in multiple energy bins, which is expected to further improve the signal-to-noise ratio for material-specific imaging. In this review, the underlying motivation and physical principles of dual- or multi-energy CT are reviewed and each of the current technical approaches is described. In addition, current and evolving clinical applications are introduced.
          Article 0 comments Cited 327 times – based on 0 reviews     Review now
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            Adaptive radiotherapy: The Elekta Unity MR-linac concept

            Dennis Winkel, Gijsbert Bol, Petra Kroon … (2019)
            Highlights • The Elekta Unity MR-linac adaptive radiotherapy concept is explained. • The adapt to shape and adapt to position workflows are compared. • Different methods for dose re-calculation and optimization are discussed. • Full online re-planning is the most robust adaptive planning method for the Unity. • Faster methods are available, but should be dosimetrically explored per use case.
            Article 0 comments Cited 209 times – based on 0 reviews     Review now
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              A review of substitute CT generation for MRI-only radiation therapy

              Jens Edmund, Tufve Nyholm (2017)
              Radiotherapy based on magnetic resonance imaging as the sole modality (MRI-only RT) is an area of growing scientific interest due to the increasing use of MRI for both target and normal tissue delineation and the development of MR based delivery systems. One major issue in MRI-only RT is the assignment of electron densities (ED) to MRI scans for dose calculation and a similar need for attenuation correction can be found for hybrid PET/MR systems. The ED assigned MRI scan is here named a substitute CT (sCT). In this review, we report on a collection of typical performance values for a number of main approaches encountered in the literature for sCT generation as compared to CT. A literature search in the Scopus database resulted in 254 papers which were included in this investigation. A final number of 50 contributions which fulfilled all inclusion criteria were categorized according to applied method, MRI sequence/contrast involved, number of subjects included and anatomical site investigated. The latter included brain, torso, prostate and phantoms. The contributions geometric and/or dosimetric performance metrics were also noted. The majority of studies are carried out on the brain for 5–10 patients with PET/MR applications in mind using a voxel based method. T1 weighted images are most commonly applied. The overall dosimetric agreement is in the order of 0.3–2.5%. A strict gamma criterion of 1% and 1mm has a range of passing rates from 68 to 94% while less strict criteria show pass rates > 98%. The mean absolute error (MAE) is between 80 and 200 HU for the brain and around 40 HU for the prostate. The Dice score for bone is between 0.5 and 0.95. The specificity and sensitivity is reported in the upper 80s% for both quantities and correctly classified voxels average around 84%. The review shows that a variety of promising approaches exist that seem clinical acceptable even with standard clinical MRI sequences. A consistent reference frame for method benchmarking is probably necessary to move the field further towards a widespread clinical implementation.
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                Author and article information

                Contributors
                Matthijs Ferdinand Kruis: matthijs.kruis@philips.com
                Journal
                Journal ID (nlm-ta): J Appl Clin Med Phys
                Journal ID (iso-abbrev): J Appl Clin Med Phys
                Journal ID (doi): 10.1002/(ISSN)1526-9914
                Journal ID (publisher-id): ACM2
                Title: Journal of Applied Clinical Medical Physics
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 1526-9914
                Publication date (Electronic): 07 November 2021
                Publication date Collection: January 2022
                Volume: 23
                Issue: 1 ( doiID: 10.1002/acm2.v23.1 )
                Electronic Location Identifier: e13468
                Affiliations
                [ 1 ] Clinical Science CT Philips Healthcare Best The Netherlands
                Author notes
                [*] [* ]Correspondence

                Matthijs Ferdinand Kruis, Clinical Science CT, Philips Healthcare, Best, The Netherlands. Email: matthijs.kruis@ 123456philips.com

                Article
                Publisher ID: ACM213468
                DOI: 10.1002/acm2.13468
                PMC ID: 8803285
                PubMed ID: 34743405
                SO-VID: 37419045-12b5-43c2-8ea9-0b1f9b0cf944
                Copyright © © 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 13 October 2021
                Date received : 22 June 2022
                Date accepted : 19 October 2021
                Page count
                Figures: 3, Tables: 0, Pages: 17, Words: 12774
                Categories
                Subject: Review Article
                Subject: Review Article
                Custom metadata
                source-schema-version-number 2.0
                cover-date January 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.0 mode:remove_FC converted:31.01.2022

                Keywords: conventional ct,dose calculation,dual‐energy ct,material decomposition,proton therapy,quantification,radiotherapy,tumor visibility,spectral ct
                Data availability:
                Keywords: conventional ct, dose calculation, dual‐energy ct, material decomposition, proton therapy, quantification, radiotherapy, tumor visibility, spectral ct

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