Virtual unenhanced dual-energy computed tomography for photon radiotherapy: The effect on dose distribution and cone-beam computed tomography based position verification.

Background And Purpose: Virtual Unenhanced images (VUE) from contrast-enhanced dual-energy computed tomography (DECT) eliminate manual suppression of contrast-enhanced structures (CES) or pre-contrast scans. CT intensity decreases in high-density structures outside the CES following VUE algorithm application. This study assesses VUE's impact on the radiotherapy workflow of gynecological tumors, comparing dose distribution and cone-beam CT-based (CBCT) position verification to contrast-enhanced CT (CECT) images.