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To develop and evaluate—in a proof-of-concept configuration—a novel iterative reconstruction algorithm (DIRA) for quantitative determination of elemental composition of patient tissues for application to brachytherapy with low energy (< 50 keV) photons and proton therapy.DIRA was designed as a model-based iterative reconstruction algorithm, which uses filtered backprojection, automatic segmentation and multimaterial tissue decomposition. The evaluation was done for a phantom derived from the voxelized ICRP 110 male phantom. Soft tissues were decomposed to the lipid, protein and water triplet, bones were decomposed to the compact bone and bone marrow doublet. Projections were derived using the Drasim simulation code for an axial scanning configuration resembling a typical DECT (dual-energy CT) scanner with 80 kV and Sn140 kV x-ray spectra. The iterative loop produced mono-energetic images at 50 and 88 keV without beam hardening artifacts. Different noise levels were considered: no noise, a typical noise level in diagnostic imaging and reduced noise level corresponding to tenfold higher doses. An uncertainty analysis of the results was performed using type A and B evaluations. The two approaches were compared.Linear attenuation coefficients averaged over a region were obtained with relative errors less than 0.5% for all evaluated regions. Errors in average mass fractions of the three-material decomposition were less than 0.04 for no noise and reduced noise levels and less than 0.11 for the typical noise level. Mass fractions of individual pixels were strongly affected by noise, which slightly increased after the first iteration but subsequently stabilized. Estimates of uncertainties in mass fractions provided by the type B evaluation differed from the type A estimates by less than 1.5% for most cases. The algorithm was fast, the results converged after 5 iterations. The algorithmic complexity of forward polyenergetic projection calculation was much reduced by using material doublets and triplets.The simulations indicated that DIRA is capable of determining elemental composition of tissues, which are needed in brachytherapy with low energy (< 50 keV) photons and proton therapy. The algorithm provided quantitative monoenergetic images with beam hardening artifacts removed. Its convergence was fast, image sharpness expressed via the modulation transfer function was maintained, and image noise did not increase with the number of iterations.