Quantitative accuracy of CT numbers: Theoretical analyses and experimental studies

The CT number accuracy, that is, CT number bias, plays an important role in clinical diagnosis. When strategies to reduce radiation dose are discussed, it is important to make sure that the CT number bias is controlled within an acceptable range. The purpose of this paper was to investigate the dependence of CT number bias on radiation dose level and on image contrast (i.e., the difference in CT number between the ROI and the background) in Computed Tomography (CT).

A lesion-background model was introduced to theoretically study how the CT number bias changes with radiation exposure level and with CT number contrast when a simple linear reconstruction algorithm such as filtered backprojection (FBP) is used. The theoretical results were validated with experimental studies using a benchtop CT system equipped with a photon-counting detector (XC-HYDRA FX50, XCounter AB, Sweden) and a clinical diagnostic MDCT scanner (Discovery CT750 HD, GE Healthcare, Waukesha, WI, USA) equipped with an energy-integrating detector. The Catphan phantom (Catphan 600, the Phantom Laboratory, Salem, NY, USA) was scanned at different mAs levels and 50 scans were performed for each mAs. The bias of CT number was evaluated for each combination of mAs and ROIs with different contrast levels. An anthropomorphic phantom (ATOM 10-year-old phantom, Model 706, CIRS Inc. Norfolk, VA, USA) with much more heterogeneous object content was used to test the applicability of the theory to the more general image object cases.

Both theoretical and experimental studies showed that the CT number bias is inversely proportional to the radiation exposure level yet linearly dependent on the CT number contrast between the lesion and the background, that is, $\text{Bias}\left({\hat{\mu }}_1^{\mathrm{FBP}}\right)=\frac{\alpha }{\mathrm{mAs}}(1+\beta \Delta HU)$ .

The quantitative accuracy of CT numbers can be problematic and thus needs some extra attention when radiation dose is reduced. In this work, we showed that the bias of the FBP reconstruction increases as mAs is reduced; both positive and negative bias can be observed depending on the contrast difference between a targeted ROI and its surrounding background tissues.