To properly target tumors during preoperative chemoradiotherapy, differentiated thyroid carcinoma (DTC) must be careful. This method increases treatment success and decreases recurrence. Ultrasound coupled with SPECT/CT may provide novel localization and dose planning possibilities. Many systems solely use anatomical or functional imaging. This may result in insufficient dosage delivery and wasted radiation exposure to healthy tissues. These issues are addressed by Dual-Modality Imaging-Guided Adaptive Chemoradiotherapy Planning (DMI-ACP). This innovative approach combines real-time ultrasound imaging with 6 Å SPECT/CT imaging for precise tumor delineation and tailored dosimetry. This system enables clinicians to adjust chemoradiotherapy regimens by seamlessly integrating functional iodine absorption data with anatomical characteristics, thereby targeting therapy to cancerous areas. The outcomes of this method for patients with DTC were promising, including better lesion targeting, reduced radiation exposure to healthy tissues, and improved chemotherapeutic dose distribution. In clinical evaluations, the DMI-ACP framework demonstrated a sensitivity of 94% and a specificity of 89% in identifying malignant lesions compared with traditional imaging techniques. Furthermore, the integration of adaptive planning resulted in a 20% improvement in tumor control probability and a 15% reduction in exposure to surrounding healthy tissue, as assessed through dosimetric analysis. 2023075 Nanjing Drum Tower Hospital Group Suqian Hospital/The Affiliated Suqian Hospital of Xuzhou Medical University.