ArticleTranslational pediatrics2026
Can virtual non-contrast images replace true non-contrast images to calculate dose in children's craniospinal irradiation proton therapy plan?
Article in Translational pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: There is consensus that non-contrast computed tomography (CT) image should be used for radiotherapy dose calculation. Although the enhanced CT can bring better target delineation for radiotherapy, it may also bring deviation to the Hounsfield unit (HU) values and furthermore dosimetry errors, especially in proton radiotherapy. Since the literature proposes that virtual non-contrast (VNC) CT can be used for photon radiotherapy dose calculation, this study aimed to investigate whether VNC can also be used for proton radiotherapy dose calculation, especially in children's craniospinal irradiation (CSI) proton therapy plans. Methods: Five patients who underwent dual-energy computed tomography (DECT) for CSI CT simulation were retrospectively analyzed. During the arterial phase of the CT scan, the spinal volume was the clinical target volume (CTV) and organs at risk (OARs) were delineated. Meanwhile, a protective ring was created by expanding 3 mm around the CTV. Subsequently, these were transferred to both true non-contrast (TNC) images and VNC images generated from DECT. We generated the planning target volume (PTV) by a 2-4 mm isotropic expansion from the CTV. The Eclipse treatment planning system generated radiotherapy treatment plans for each patient, with dose-volume histograms (DVH) calculated based on the dose distribution. VNC-based plans were transplanted onto the TNC images to simulate the real Results: During CT value measurement, the attenuation of the VNC images was lower than that of the TNC images. To further investigate this difference, a protective ring added 3 mm outside the target area can not only prevent dose damage caused by patient movement, but also enable a more detailed observation of changes in the isodose lines. Additionally, the volume difference between the CTV and prescribed dose was calculated for both plans. Analysis of the DVH curves of the patients revealed that the entire spinal cord radiotherapy plan had the largest difference. In the comparison of the TNC and VNC radiotherapy plans, the maximum doses differed in the doses covering 100% and 95% of the volume in the whole spinal cord plans by 8%. Conclusions: Our results suggest that VNC imaging cannot replace TNC imaging for proton radiotherapy planning in patients with CSI.
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