{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:50:29Z","timestamp":1792788629202,"version":"4.5.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Foundation of Korea","award":["RS-2024-00339804"],"award-info":[{"award-number":["RS-2024-00339804"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the impact of stopping-power ratio (SPR) predictions derived from dual-layer detector-based spectral CT (DLCT) on conventional single-energy CT (SECT)-based carbon-ion treatment planning for thoracic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty patients with thoracic cancer who underwent non-contrast DLCT were retrospectively included. DLCT-based SPR images were generated from effective atomic number and relative electron density maps using the Bethe equation. SECT-based SPR was derived using a Hounsfield unit look-up table generated via stoichiometric calibration of a commercial electron density phantom. Using the same phantom, a phantom-based prediction assessment was performed by comparing SECT- and DLCT-based SPR predictions with theoretical SPR values for the inserts. For patient analysis, normal-tissue SPR values derived from SECT and DLCT were compared. Carbon-ion treatment plans were first generated based on SECT images and then recalculated using DLCT-derived SPR images. Range differences in the beam\u2019s-eye view and dose\u2013volume histogram parameters for the planning target volume and organs at risk were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the phantom-based assessment, the root-mean-square error relative to the theoretical SPR was 5.57% for SECT and 2.83% for DLCT. In patient images, mean SPR differences between SECT and DLCT were 3.62% for the lungs, 1.93% for the esophagus, 0.04% for the heart, 0.93% for the spinal cord, and 1.53% for the ribs. Across the patient cohort, the mean recalculated range difference was 0.71\u2009\u00b1\u20090.89 mm, corresponding to a relative difference of 0.60\u2009\u00b1\u20090.67%. No statistically significant differences were observed in target dose metrics, whereas selected organ-at-risk metrics showed statistically significant differences between SECT-based plans and DLCT-based recalculations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DLCT-derived SPR prediction showed better agreement with theoretical phantom SPR values in the phantom-based prediction assessment and produced tissue-dependent SPR differences in thoracic patient images compared with conventional SECT-based prediction. Recalculation on DLCT-derived SPR maps resulted in modest but systematic range differences and limited changes in selected dose metrics. These results may inform the implementation and future independent validation of patient-specific DLCT-based SPR workflows in carbon-ion treatment planning for thoracic cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358184","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:37:12Z","timestamp":1789493832000},"page":"e0358184","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of dual-layer spectral CT-derived stopping power ratio on single-energy CT-based carbon-ion treatment planning for thoracic cancer"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2155-3793","authenticated-orcid":true,"given":"Euntaek","family":"Yoon","sequence":"first","affiliation":[{"name":"Seoul National University Hospital","place":["Seoul, Republic of Korea"],"department":["Department of Radiation 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Korea"]},{"name":"Seoul National University College of Medicine","place":["Seoul, Republic of Korea"],"department":["Department of Radiation Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeongmin","family":"Jin","sequence":"additional","affiliation":[{"name":"Seoul National University Hospital","place":["Seoul, Republic of Korea"],"department":["Department of Radiation Oncology"]},{"name":"Biomedical Research Institute, Seoul National University Hospital","place":["Seoul, Republic of Korea"]},{"name":"Project Group of the Gijang Heavy Ion Medical Accelerator, Seoul National University Hospital","place":["Seoul, Republic of Korea"]},{"name":"Seoul National University College of Medicine","place":["Seoul, Republic of Korea"],"department":["Department of Radiation Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5713-3887","authenticated-orcid":true,"given":"Tae 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Peters","year":"2023","journal-title":"Radiother Oncol"},{"issue":"1","key":"pone.0358184.ref007","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1088\/0031-9155\/41\/1\/009","article-title":"The calibration of CT Hounsfield units for radiotherapy treatment planning","volume":"41","author":"U Schneider","year":"1996","journal-title":"Phys Med Biol"},{"issue":"1","key":"pone.0358184.ref008","doi-asserted-by":"crossref","first-page":"62","DOI":"10.14338\/IJPT-20-00075.1","article-title":"Dual-Energy Computed Tomography Proton-Dose Calculation with Scripting and Modified Hounsfield Units","volume":"8","author":"A Kassaee","year":"2021","journal-title":"Int J Part Ther"},{"issue":"9","key":"pone.0358184.ref009","doi-asserted-by":"crossref","first-page":"095007","DOI":"10.1088\/1361-6560\/ab735e","article-title":"Pre-clinical evaluation of dual-layer spectral computed tomography-based stopping power prediction for particle therapy planning at the Heidelberg Ion Beam Therapy 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images","volume":"43","author":"N Hudobivnik","year":"2016","journal-title":"Med Phys"},{"issue":"3","key":"pone.0358184.ref016","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.radonc.2017.09.042","article-title":"Dual-energy CT based proton range prediction in head and pelvic tumor patients","volume":"125","author":"P Wohlfahrt","year":"2017","journal-title":"Radiother Oncol"},{"key":"pone.0358184.ref017","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.phro.2018.04.002","article-title":"Comparison of single and dual energy CT for stopping power determination in proton therapy of head and neck cancer","volume":"6","author":"VT Taasti","year":"2018","journal-title":"Phys Imaging Radiat Oncol"},{"issue":"4","key":"pone.0358184.ref018","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.ijrobp.2018.06.044","article-title":"Clinical Feasibility of Single-Source Dual-spiral 4D Dual-Energy CT for Proton Treatment Planning Within the Thoracic Region","volume":"102","author":"P Wohlfahrt","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"pone.0358184.ref019","article-title":"Feasibility study for proton dose calculation of esophageal squamous cell carcinoma based on stopping power ratio directly derived from dual energy CT","author":"M Li","year":"2025","journal-title":"Frontiers in Oncology"},{"issue":"1","key":"pone.0358184.ref020","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5152\/dir.2019.19136","article-title":"Technical background of a novel detector-based approach to dual-energy computed tomography","volume":"26","author":"NG Hokamp","year":"2020","journal-title":"Diagnostic and Interventional Radiology"},{"issue":"5","key":"pone.0358184.ref021","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1088\/0031-9155\/21\/5\/002","article-title":"Energy-selective reconstructions in X-ray computerized tomography","volume":"21","author":"RE Alvarez","year":"1976","journal-title":"Phys Med Biol"},{"issue":"6","key":"pone.0358184.ref022","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s13244-017-0571-4","article-title":"Detector-based spectral CT with a novel dual-layer technology: principles and applications","volume":"8","author":"N Rassouli","year":"2017","journal-title":"Insights Imaging"},{"issue":"4","key":"pone.0358184.ref023","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1002\/mp.13404","article-title":"Technical Note: Relative proton stopping power estimation from virtual monoenergetic images reconstructed from dual-layer computed tomography","volume":"46","author":"G Landry","year":"2019","journal-title":"Med Phys"},{"key":"pone.0358184.ref024","unstructured":"Romman Z, Yagil Y, Finzi D, Wainer N, Milstein D. Using spectral results in CT imaging. 2015."},{"issue":"6","key":"pone.0358184.ref025","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1002\/mp.12903","article-title":"Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual-layer dual-energy computed tomography system","volume":"45","author":"C-H Hua","year":"2018","journal-title":"Med Phys"},{"issue":"20","key":"pone.0358184.ref026","doi-asserted-by":"crossref","DOI":"10.1088\/0031-9155\/61\/20\/N542","article-title":"Effective particle energies for stopping power calculation in radiotherapy treatment planning with protons and helium, carbon, and oxygen ions","volume":"61","author":"T Inaniwa","year":"2016","journal-title":"Phys Med Biol"},{"issue":"2","key":"pone.0358184.ref027","article-title":"Report 49","author":"MJ Berger","year":"1993","journal-title":"Journal of the International Commission on Radiation Units and 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Ma","year":"2025","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"pone.0358184.ref031","doi-asserted-by":"crossref","first-page":"163","DOI":"10.3109\/0284186X.2015.1088169","article-title":"Incidence, risk factors, and dose-volume relationship of radiation-induced rib fracture after carbon ion radiotherapy for lung cancer","volume":"55","author":"T Abe","year":"2016","journal-title":"Acta Oncol"},{"issue":"22","key":"pone.0358184.ref032","doi-asserted-by":"crossref","first-page":"6721","DOI":"10.1088\/0031-9155\/55\/22\/008","article-title":"Treatment planning for a scanned carbon beam with a modified microdosimetric kinetic model","volume":"55","author":"T Inaniwa","year":"2010","journal-title":"Phys Med Biol"},{"key":"pone.0358184.ref033","doi-asserted-by":"crossref","first-page":"109640","DOI":"10.1016\/j.radonc.2023.109640","article-title":"Clinical results of carbon ion radiotherapy for inoperable stage I non-small cell lung cancer: A Japanese national 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Optimal Energy Level of Virtual Monochromatic Images From Spectral CT for Reducing Beam-Hardening Artifacts Due to Contrast Media in the Thorax","volume":"211","author":"C Kim","year":"2018","journal-title":"AJR Am J Roentgenol"},{"issue":"1","key":"pone.0358184.ref038","doi-asserted-by":"crossref","first-page":"226","DOI":"10.21037\/qims-20-435","article-title":"CT artifacts after contrast media injection in chest imaging: evaluation of post-processing algorithms, virtual monoenergetic images and their combination for artifact reduction","volume":"11","author":"A Gupta","year":"2021","journal-title":"Quant Imaging Med Surg"},{"key":"pone.0358184.ref039","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ejmp.2018.11.008","article-title":"Estimation of electron density, effective atomic number and stopping power ratio using dual-layer computed tomography for radiotherapy treatment planning","volume":"56","author":"S Ohira","year":"2018","journal-title":"Phys Med"},{"issue":"3","key":"pone.0358184.ref040","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.radonc.2009.03.022","article-title":"Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy of non-small cell lung cancer: a dose- and volume-response analysis","volume":"91","author":"N Pettersson","year":"2009","journal-title":"Radiother Oncol"},{"issue":"3","key":"pone.0358184.ref041","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.ijrobp.2012.01.027","article-title":"Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy: risk factors and dose-volume relationship","volume":"84","author":"K Asai","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"pone.0358184.ref042","doi-asserted-by":"crossref","first-page":"106","DOI":"10.21037\/tlcr.2018.04.06","article-title":"Rationale and early outcomes for the management of thymoma with proton 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