“…Although a dedicated DE-CBCT system for IGRT has not been commercially available, several implementations have been reported by performing two-scan approaches (Men et al 2015(Men et al , 2017, or developing novel single-scan methods (Shi et al 2020b, Jiang et al 2021, Ståhl et al 2021, Wang et al 2021. Most existing studies have focused on the impact of new algorithms or hardware modifications on image quality (Ren et al 2016, Tse et al 2018, Skaarup et al 2019, Cassetta et al 2020, Shi et al 2020a, Schröder et al 2022, However, less attention has been paid to the scanning protocols of DE-CBCT which are more complex than those for conventional CBCT due to the increased number of possible parameter combinations involving two energies. Therefore, the definition of image quality for DE-CBCT should be more comprehensive and include the accuracy of material decomposition, in addition to conventional metrics that describe anatomic visibility, such as contrast-to-noise ratio (CNR).…”