{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:00:53Z","timestamp":1790211653353,"version":"4.1.0"},"reference-count":56,"publisher":"SPIE-Intl Soc Optical Eng","issue":"02","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2140001"],"award-info":[{"award-number":["2140001"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Med. Imag."],"published-print":{"date-parts":[[2024,3,4]]},"abstract":"<jats:p>PurposeSingle-energy computed tomography (CT) often suffers from poor contrast yet remains critical for effective radiotherapy treatment. Modern therapy systems are often equipped with both megavoltage (MV) and kilovoltage (kV) X-ray sources and thus already possess hardware for dual-energy (DE) CT. There is unexplored potential for enhanced image contrast using MV-kV DE-CT in radiotherapy contexts.ApproachA single-line integral toy model was designed for computing basis material signal-to-noise ratio (SNR) using estimation theory. Five dose-matched spectra (3\u00a0kV, 2 MV) and three variables were considered: spectral combination, spectral dose allocation, and object material composition. The single-line model was extended to a simulated CT acquisition of an anthropomorphic phantom with and without a metal implant. Basis material sinograms were computed and synthesized into virtual monoenergetic images (VMIs). MV-kV and kV-kV VMIs were compared with single-energy images.ResultsThe 80\u00a0kV-140\u00a0kV pair typically yielded the best SNRs, but for bone thicknesses &gt;8 cm, the detunedMV-80\u00a0kV pair surpassed it. Peak MV-kV SNR was achieved with \u223c90% dose allocated to the MV spectrum. In CT simulations of the pelvis with a steel implant, MV-kV VMIs yielded a higher contrast-to-noise ratio (CNR) than single-energy CT and kV-kV DE-CT. Without steel, the MV-kV VMIs produced higher contrast but lower CNR than single-energy CT.ConclusionsThis work analyzes MV-kV DE-CT imaging and assesses its potential advantages. The technique may be used for metal artifact correction and generation of VMIs with higher native contrast than single-energy CT. 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