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The imaging sensitivity of proton radiography has been studied and compared with kV and MV x-ray imaging using Monte Carlo simulations. A phantom was specifically modeled using 21 different material inserts with densities ranging from 0.001 to 1.92 g cm− 3. These simulations were run using the MGH double scattered proton beam, scanned pencil proton beams from 200 to 490 MeV, as well as pure 50 keV, 100 keV, 1 MeV and 2 MeV gamma x-ray beams. In order to compare the physics implied in both proton and photon radiography without being biased by the current state of the art in detector technology, the detectors were considered perfect. Along with spatial resolution, the contrast-to-noise ratio was evaluated and compared for each material. These analyses were performed using radiographic images that took into account the following: only primary protons, both primary and secondary protons, and …