Technical Note: The use of DirectDensity(TM) and dual‐energy CT in the radiation oncology clinic

PURPOSE: Two new tools available in Radiation Oncology clinics are Dual‐energy CT (DECT) and Siemens’ DirectDensity™ (DD) reconstruction algorithm, which allows scans of any kV setting to use the same calibration. This study demonstrates why DD scans should not be used in combination with DECT and quantifies the magnitude of potential errors in image quality and dose. METHODS: A CatPhan 504 phantom was scanned with a dual‐pass DECT and reconstructed with many different kernels, including several DD kernels. The HU values of various inserts were measured. The RANDO (®) man phantom was also scanned. Bone was contoured and then histograms of the bone HU values were analyzed for Filtered‐Backprojection (FBP) and DD reconstructions of the 80 and 140 kV scans, as well as several virtual, monoenergetic reconstructions generated from FBP and DD reconstructions. “Standard” dose distributions were calculated on several reconstructions of both phantoms for comparison. RESULTS: The DD kernel overcorrected the high‐Z material inserts relative to bone, giving an excessively low relative electron density (RED). A unique artifact was observed in the high density inserts of the CatPhan in the monoenergetic scans when utilizing a DD kernel, due to the overcorrection in the DD scan of the material, especially at lower kV. CONCLUSIONS: While DD and DECT perform as expected when used independently, errors from their combined use were demonstrated. Dose errors from misuse of the DD kernel with DECT post‐processing were as large as 2.5%. The DECT post‐processing was without value because the HU differences between low and high energy were removed by the DD kernel. When using DD and DECT, we recommend the use of a DD reconstruction of the high energy scan for the dose calculation, and use of a FBP filter for the low and high energy scans for the DECT post‐processing.