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Technical Brief

Methods for Post Hoc Quantitative Computed Tomography Bone Density Calibration: Phantom-Only and Regression

[+] Author and Article Information
Jacob M. Reeves

Department of Mechanical Engineering,
Western University Canada,
1151 Richmond Street,
London, ON N6A3K7, Canada
e-mail: jreeves3@uwo.ca

Nikolas K. Knowles

Department of Biomedical Engineering,
Western University Canada,
1151 Richmond Street,
London, ON N6A3K7, Canada
e-mail: nknowle@uwo.ca

George S. Athwal

Roth|McFarlane Hand and Upper Limb Centre,
268 Grosvenor Street,
London, ON N6A4V2, Canada
e-mail: gathwal@uwo.ca

James A. Johnson

Department of Mechanical Engineering,
Western University Canada,
1151 Richmond Street,
London, ON N6A3K7, Canada
e-mail: jajohnso@uwo.ca

Manuscript received July 20, 2017; final manuscript received April 21, 2018; published online May 24, 2018. Assoc. Editor: Joel D. Stitzel.

J Biomech Eng 140(9), 094501 (May 24, 2018) (6 pages) Paper No: BIO-17-1318; doi: 10.1115/1.4040122 History: Received July 20, 2017; Revised April 21, 2018

Quantitative computed tomography (qCT) relies on calibrated bone mineral density data. If a calibration phantom is absent from the CT scan, post hoc calibration becomes necessary. Scanning a calibration phantom after-the-fact and applying that calibration to uncalibrated scans has been used previously. Alternatively, the estimated density is known to vary with CT settings, suggesting that it may be possible to predict the calibration terms using CT settings. This study compares a novel CT setting regression method for post hoc calibration to standard and post hoc phantom-only calibrations. Five cadaveric upper limbs were scanned at 11 combinations of peak tube voltage and current (80–140 kV and 100–300 mA) with two calibration phantoms. Density calibrations were performed for the cadaver scans, and scans of the phantoms alone. Stepwise linear regression determined if the calibration equation terms were predictable using peak tube voltage and current. Peak tube voltage, but not current, was significantly correlated with regression calibration terms. Calibration equation slope was significantly related to the type of phantom (p < 0.001), calibration method (p = 0.026), and peak tube voltage (p < 0.001), but not current (p = 1.000). The calibration equation vertical intercept was significantly related to the type of phantom (p < 0.001), and peak tube voltage (p = 0.006), but not calibration method (p = 0.682), or current (p = 0.822). Accordingly, regression can correlate peak tube voltage with density calibration terms. Suggesting that, while standard qCT calibration is preferable, regression calibration may be an acceptable post hoc method when necessary.

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Figures

Grahic Jump Location
Fig. 1

Process flow diagram, outlining the sequence of events for the phantom-only, regression and standard calibration methods

Grahic Jump Location
Fig. 2

Plots of ash density percent difference (relative to proper calibration equation terms) for both phantom-only and regression calibration methods

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Fig. 3

Bland–Altman plots for density calibration equation slope and vertical intercept terms, comparing phantom-only and regression calibration methods

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