Effect of Patient Positioning on CT Number Accuracy: A Phantom Study Comparing Energy Integrating and Deep Silicon...

Patient positioning during clinical practice can be challenging, and mispositioning leads to a change in CT number. CT number fluctuation was assessed in single-energy (SE) EID, dual-energy (DE) EID, and deep silicon photon-counting detector (PCD) CT over water-equivalent diameter (WED) with different mispositions.

A phantom containing five clinically relevant inserts (Mercury Phantom, Gammex) was scanned on a clinical EID CT and a deep silicon PCD CT prototype at vertical positions of 0, 4, 8, and 12 cm. EID scans used 120 kV and rapid kV-switching DE techniques. CT number was calculated for air, water, polystyrene, iodine 10 mg/mL, and bone. Ideal CT numbers were calculated using the NIST XCOM database toolkit. Comparison of measured to ideal CT number utilized relative root mean square error (RMSE). Trends in CT number versus WED were compared using linear regression and statistical comparisons to test for differences in slope.

No statistical difference of CT number with mispositioning was seen between acquisition modes. CT number fluctuation was larger due to WED than mispositioning for all material inserts. Water, iodine, and bone, for deep silicon PCD CT had statistically significant ( P  < 0.05) smaller slopes compared to EIDof CT number over WED for all tested mispositions. The accuracy of deep silicon PCD CT was higher than either SE or DE EID CT for all materials at all mispositions except for polystyrene.

WED (ie, patient size) contributes to CT number fluctuation more than mispositioning. The change in CT number was significantly smaller, and CT number accuracy was higher for deep silicon PCD CT in this phantom study.