title: A simulation study on proton computed tomography (CT) stopping power accuracy using dual energy CT scans as benchmark.
abstract: BACKGROUND
  Accurate stopping power estimation is crucial for treatment planning in proton therapy, and the uncertainties in stopping power are currently the largest contributor to the employed dose margins. Dual energy x-ray computed tomography (CT) (clinically available) and proton CT (in development) have both been proposed as methods for obtaining patient stopping power maps. The purpose of this work was to assess the accuracy of proton CT using dual energy CT scans of phantoms to establish reference accuracy levels.
  
  
  METHODS
  A CT calibration phantom and an abdomen cross section phantom containing inserts were scanned with dual energy and single energy CT with a state-of-the-art dual energy CT scanner. Proton CT scans were simulated using Monte Carlo methods. The simulations followed the setup used in current prototype proton CT scanners and included realistic modeling of detectors and the corresponding noise characteristics. Stopping power maps were calculated for all three scans, and compared with the ground truth stopping power from the phantoms.
  
  
  RESULTS
  Proton CT gave slightly better stopping power estimates than the dual energy CT method, with root mean square errors of 0.2% and 0.5% (for each phantom) compared to 0.5% and 0.9%. Single energy CT root mean square errors were 2.7% and 1.6%. Maximal errors for proton, dual energy and single energy CT were 0.51%, 1.7% and 7.4%, respectively.
  
  
  CONCLUSIONS
  Better stopping power estimates could significantly reduce the range errors in proton therapy, but requires a large improvement in current methods which may be achievable with proton CT.
authors.affiliation: a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: David C
authors.initials: DC
authors.lastname: Hansen
authors.affiliation: b Massachussetts General Hospital and Harvard Medical School , Boston , USA.
authors.forename: Joao
authors.initials: J
authors.lastname: Seco
authors.affiliation: c Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.
authors.forename: Thomas Sangild
authors.initials: TS
authors.lastname: Sørensen
authors.affiliation: d Department of Medical Physics , Aarhus University Hospital , Denmark.
authors.forename: Jørgen Breede Baltzer
authors.initials: JB
authors.lastname: Petersen
authors.affiliation: e Department of Radiology , Maastricht University Medical Center (MUMC) , The Netherlands.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.affiliation: f Department of Radiation Oncology (MAASTRO) , Maastricht University Medical Center (MUMC) , Maastricht , the Netherlands.|g Medical Physics Unit, Department of Oncology , McGill University , Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Verhaegen
authors.affiliation: f Department of Radiation Oncology (MAASTRO) , Maastricht University Medical Center (MUMC) , Maastricht , the Netherlands.|h Faculty of Physics, Department of Medical Physics , Ludwig-Maximilians-University , Munich , Germany.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Landry
mesh_terms: D019985:Benchmarking; D002138:Calibration; D003198:Computer Simulation; D006801:Humans; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D061766:Proton Therapy; D015900:Radiography, Dual-Energy Scanned Projection / Q000295:instrumentation*; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*