Accuracy of CT numbers and electron density calibration for mixtures of materials with low and high-atomic number

Abstract In computed tomography (CT) materials with high-atomic number Z cause image artefacts, thus, errors in CT numbers given in Hounsfield Units (HU). Also, the conventional HU scale (CHU) implemented in CT scanners is truncated, i.e., it does not cover high-Z materials. These restrictions lead to incorrect mapping of CT numbers to electron density, which are used in radiotherapy (RT) treatment planning systems (TPS). Even analytical conversion methods are only permissible for tissue-equivalent materials. In terms of HU-to-density conversion in RT TPS, we investigated the CT numbers of material mixtures up to Z<29 at the CHU and an extended-HU (EHU) scale, respectively, and quantify the systematic errors of image artefacts. In [1] the feasibility of a stoichiometric analytical calibration method were analyzed for metals and adapted for higher accurcy, for energies of 80 kV and 120 kV. In this work, we add results for 100 kV and 140 kV to cover the wide diagnostic range. The CT numbers are effected by physical and machine-based properties and depend strongly on the energy, e.g., for Cu a HU difference of 6 171HU at 80 kV and 140 kV occured. The analytical calibration parameters change with energy by a factor between 2 and 10 depending on the physical process. Although for high- Z materials our calibration procedure remains in conflict with rigorous physics [2], it offers an improved and a practical way to predict electron densities from CT numbers.