On the equivalence of image-based dual-energy CT methods for the determination of electron density and effective atomic number in radiotherapy

Dual-energy computed tomography enables the determination of relative electron density and effective atomic number. As this can increase accuracy in radiotherapy treatment planning, a substantial number of algorithms for the determination of the two quantities has been suggested – most of them based on reconstructed CT images. We show that many of these methods share a common theoretical framework. Equations can be transformed from one method to the other by re-definition of the calibration parameters. We suggest that further work should be spent on practical calibration and the reliability of CT numbers rather than on the theoretical framework.