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American Association of Physicists in Medicine

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Medical Physics

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The purpose of this work is to investigate the use of low‐energy monoenergetic decompositions obtained from dual‐energy CT (DECT) to enhance image contrast and the detection of radiation‐induced changes of CT textures in pancreatic cancer.


The DECT data acquired for 10 consecutive pancreatic cancer patients during routine nongated CT‐guided radiation therapy (RT) using an in‐room CT (Definition AS Open, Siemens Healthcare, Malvern, PA) were analyzed. With a sequential DE protocol, the scanner rapidly performs two helical acquisitions, the first at a tube voltage of 80 kVp and the second at a tube voltage of 140 kVp. Virtual monoenergetic images across a range of energies from 40 to 140 keV were reconstructed using an image‐based material decomposition. Intravenous (IV) bolus‐free contrast enhancement in pancreas patient tumors was measured across a spectrum of monoenergies. For treatment response assessment, the changes in CT histogram features (including mean CT number (MCTN), entropy, kurtosis) in pancreas tumors were measured during treatment. The results from the monoenergetic decompositions were compared to those obtained from the standard 120 kVp CT protocol for the same subjects.


Data of monoenergetic decompositions of the 10 patients confirmed the expected enhancement of soft tissue contrast as the energy is decreased. The changes in the selected CT histogram features in the pancreas during RT delivery were amplified with the low‐energy monoenergetic decompositions, as compared to the changes measured from the 120 kVp CTs. For the patients studied, the average reduction in the MCTN in pancreas from the first to the last (the 28th) treatment fraction was 4.09 HU for the standard 120 kVp and 11.15 HU for the 40 keV monoenergetic decomposition.


Low‐energy monoenergetic decompositions from DECT substantially increase soft tissue contrast and increase the magnitude of radiation‐induced changes in CT histogram textures during RT delivery for pancreatic cancer. Therefore, quantitative DECT may assist the detection of early RT response.


Accepted version. Medical Physics, Vol. 45, No. 9 (September 2018): 4238-4245. DOI. © 2018 American Association of Physicists in Medicine. Used with permission.

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