Effect of X-ray beam energy and image reconstruction technique on computed tomography numbers of various tissue equivalent materials

Introduction: Computed tomography (CT) numbers are used in radiological diagnosis, attenuation correction and radiotherapy treatment planning. Modern CT scanners use iterative reconstruction methods instead of the traditional filtered back projection (FBP). Hence, the investigation of CT number accuracy with image reconstruction techniques and X-ray tube potential (kVp) used in CT is warranted. The aim of this study is to evaluate the effect of Sinogram Affirmed Iterative Reconstruction (SAFIRE) Technique and image acquisition at different tube potentials on CT numbers of different tissue equivalent materials. Methods: Images of the Computerised Imaging Reference System Model 062M Electron Density Phantom were acquired at different tube potentials and reconstructed using FBP and different strengths of SAFIRE. Average CT numbers, in circular regions of interest, and their standard deviations were used to investigate any dependence of CT numbers on tube potentials and/or image reconstruction technique using non-parametric statistical tests with p-values set at 0.05. Results: Statistically significant differences in CT numbers were not observed (p > 0.091) between the different image reconstruction techniques. CT number of bone equivalent materials increased significantly (p < 0.015), by up to 400 Hounsfield Units, when tube potential was decreased. Such extent of CT number change over the tube potentials range used in this study may influence diagnostic outcomes in lung nodule, contrast enhanced and calcium score studies. For all other tissue equivalent materials, the CT number did not change significantly for different tube potentials. Linear relationship was observed between CT numbers and electron densities. Conclusion: The study concludes that the CT numbers of all tissues did not change significantly with image reconstruction methods. However, the CT numbers of bone equivalent materials increased with decreasing tube potentials, which may result in misrepresentation of clinical information obtained. Implications for practice: When CT images are used to extract quantitative parameters such as calcium score, to characterise lung nodules and contrast enhanced structures, the kVp used for image acquisition should be carefully selected to avoid any misrepresentation of clinical information. (C) 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.