Asynchronous calibration of a CT scanner for bone mineral density estimation: sources of error and correction.

The estimation of BMD with CT scans requires a calibration method, usually based on a phantom. In asynchronous calibration, the phantom is scanned separately from the patient. A standardized acquisition protocol must be used to avoid variations between patient and phantom. However, variations can still be induced, for example, by temporal fluctuations or patient characteristics. Based on the further use of 739 forensic and 111 clinical CT scans, this study uses the proximal femur BMD value ("total hip") to assess asynchronous calibration accuracy, using in-scan calibration as ground truth. It identifies the parameters affecting the calibration accuracy and quantifies their impact. For time interval and table height, the impact was measured by calibrating the CT scan twice (once using the phantom scan with closest acquisition parameters and once using a phantom scan with standard values) and comparing the calibration accuracy. For other parameters such as body weight, the impact was measured by computing a linear regression between parameter values and calibration accuracy. Finally, this study proposes correction methods to reduce the effect of these parameters and improve the calibration accuracy. The BMD error of the asynchronous calibration, using the phantom scan with the closest acquisition parameters, was −1.2 ± 1.7% for the forensic and − 1.6 ± 3.5% for the clinical dataset. Among the parameters studied, time interval and body weight were identified as the main sources of error for asynchronous calibration, followed by table height and reconstruction kernel. Based on these results, a correction method was proposed to improve the calibration accuracy. Lay Summary: In musculoskeletal radiology and biomechanics, BMD is a commonly used parameter to assess bone quality, bone strength, and identify bone pathologies, such as osteoporosis. BMD values can be extracted from CT scans, which are routinely performed in radiology centers. Obtaining BMD values requires an additional calibration step to transform the original CT into quantitative CT scans. The calibration method is typically based on a reference object with known densities, the calibration phantom, which is scanned with the patient or separately. In case the phantom is scanned separately, the calibration accuracy can be affected by various parameters related to the patient or to the CT acquisition protocol. In this study, we aim to identify these parameters, quantify their impact and propose a correction method to improve the calibration accuracy. Among the parameters studied, we found that the time interval between phantom and patient scans and the patient's body weight had the largest impact on the resulting BMD accuracy. Therefore, we recommend performing the phantom scan as soon as possible before or after the patient scan and applying a weight correction to the scan. Graphical Abstract [ABSTRACT FROM AUTHOR]