Simulations on Scintillator Thicknesses for Bone Mineral Density Measurement Based on Dual-Layer Flat-Panel Detectors

Background/Objectives: A dual-layer flat-panel detector (DFD), in which two flat-panel detectors are stacked vertically, enables single-shot dual-energy imaging without a fan-beam scanning and switching mechanism in conventional dual-energy X-ray absorptiometry (DXA), the clinical standard for bone mineral density (BMD). However, because single-shot BMD measurement systems using DFDs show substantial spectral overlap, their BMD measurement performance is inherently inferior to that of dual-shot systems. In this paper, we optimize the tube voltage, metal filter thickness, and CsI(Tl)-scintillator thickness so that the BMD estimation error of the single-shot method is similar to that of the double-shot method. Here, we also optimize the dual-shot approach to serve as a meaningful reference in the comparison. Methods: BMD measurement simulations were performed using a polynomial estimator based on second-order polynomial fitting of dual-energy logarithmic intensities. Performance comparison was based on noise sensitivity, quantified by the condition number and mean square error under a multiplicative noise model, and was further assessed using the equivalent energies and the bone-tissue attenuation ratios. Results: The simulation results indicate that, in the dual-shot approach, decreasing the low tube voltage is the most effective strategy for improving BMD measurement performance, whereas in the single-shot approach, reducing the upper scintillator thickness has the largest impact. Conclusions: When both approaches are evaluated under their respective optimized configurations based on synthetic simulations, the single-shot approach demonstrates that the BMD estimation error is sufficiently similar to that of the dual-shot approach, supporting its potential as a hardware-efficient alternative for BMD measurement.