The effects of beam hardening on digital subtraction radiography

Quantitative assessment of osseous changes attributable to periodontal disease is made possible by digital subtraction radiography. Tissues through which x rays travel to produce dental radiographs essential to this process alter the energy spectrum of the beam such that calibration errors result when densitometry is attempted using a homogeneous calibration standard such as a step wedge. The following controlled in vitro investigation evaluates the extent of such errors caused by these spectral differences, called beam hardening. Simulated osseous lesions of known size were computed densitometrically using selectively filtered radiation to produce the x-ray images. The resulting data confirm the theory and demonstrate with statistically meaningful accuracy that beam hardening can contribute a significant component of variance to absolute estimates of lesion size. They also suggest that other errors (probably attributable to low contrast) may be even more important at high peak kilovoltages.