The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.

Recently, it was shown that fracture risk assessment in patients with femoral bone metastases using Finite Element (FE) modeling can be performed using a calibration phantom or air-fat-muscle calibration and that non-patient-specific calibration was less favorable. The purpose of this study was to i...

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Main Authors: Ali Ataei, Jelle Eikhout, Ruud G H van Leeuwen, Esther Tanck, Florieke Eggermont
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2022-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0265524
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author Ali Ataei
Jelle Eikhout
Ruud G H van Leeuwen
Esther Tanck
Florieke Eggermont
author_facet Ali Ataei
Jelle Eikhout
Ruud G H van Leeuwen
Esther Tanck
Florieke Eggermont
author_sort Ali Ataei
collection DOAJ
description Recently, it was shown that fracture risk assessment in patients with femoral bone metastases using Finite Element (FE) modeling can be performed using a calibration phantom or air-fat-muscle calibration and that non-patient-specific calibration was less favorable. The purpose of this study was to investigate if phantomless calibration can be used instead of phantom calibration when different CT protocols are used. Differences in effect of CT protocols on Hounsfield units (HU), calculated bone mineral density (BMD) and FE failure loads between phantom and two methods of phantomless calibrations were studied. Five human cadaver lower limbs were scanned atop a calibration phantom according to a standard scanning protocol and seven additional commonly deviating protocols including current, peak kilovoltage (kVp), slice thickness, rotation time, field of view, reconstruction kernel, and reconstruction algorithm. The HUs of the scans were calibrated to BMD (in mg/cm3) using the calibration phantom as well as using air-fat-muscle and non-patient-specific calibration, resulting in three models for each scan. FE models were created, and failure loads were calculated by simulating an axial load on the femur. HU, calculated BMD and failure load of all protocols were compared between the three calibration methods. The different protocols showed little variation in HU, BMD and failure load. However, compared to phantom calibration, changing the kVp resulted in a relatively large decrease of approximately 10% in mean HU and BMD of the trabecular and cortical region of interest (ROI), resulting in a 13.8% and 13.4% lower failure load when air-fat-muscle and non-patient-specific calibrations were used, respectively. In conclusion, while we observed significant correlations between air-fat-muscle calibration and phantom calibration as well as between non-patient-specific calibration and phantom calibration, our sample size was too small to prove that either of these calibration approaches was superior. Further studies are necessary to test whether air-fat-muscle or non-patient-specific calibration could replace phantom calibration in case of different scanning protocols.
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spelling doaj.art-2f621203aec7454e8ac404af0f106bbb2022-12-22T00:43:27ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01173e026552410.1371/journal.pone.0265524The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.Ali AtaeiJelle EikhoutRuud G H van LeeuwenEsther TanckFlorieke EggermontRecently, it was shown that fracture risk assessment in patients with femoral bone metastases using Finite Element (FE) modeling can be performed using a calibration phantom or air-fat-muscle calibration and that non-patient-specific calibration was less favorable. The purpose of this study was to investigate if phantomless calibration can be used instead of phantom calibration when different CT protocols are used. Differences in effect of CT protocols on Hounsfield units (HU), calculated bone mineral density (BMD) and FE failure loads between phantom and two methods of phantomless calibrations were studied. Five human cadaver lower limbs were scanned atop a calibration phantom according to a standard scanning protocol and seven additional commonly deviating protocols including current, peak kilovoltage (kVp), slice thickness, rotation time, field of view, reconstruction kernel, and reconstruction algorithm. The HUs of the scans were calibrated to BMD (in mg/cm3) using the calibration phantom as well as using air-fat-muscle and non-patient-specific calibration, resulting in three models for each scan. FE models were created, and failure loads were calculated by simulating an axial load on the femur. HU, calculated BMD and failure load of all protocols were compared between the three calibration methods. The different protocols showed little variation in HU, BMD and failure load. However, compared to phantom calibration, changing the kVp resulted in a relatively large decrease of approximately 10% in mean HU and BMD of the trabecular and cortical region of interest (ROI), resulting in a 13.8% and 13.4% lower failure load when air-fat-muscle and non-patient-specific calibrations were used, respectively. In conclusion, while we observed significant correlations between air-fat-muscle calibration and phantom calibration as well as between non-patient-specific calibration and phantom calibration, our sample size was too small to prove that either of these calibration approaches was superior. Further studies are necessary to test whether air-fat-muscle or non-patient-specific calibration could replace phantom calibration in case of different scanning protocols.https://doi.org/10.1371/journal.pone.0265524
spellingShingle Ali Ataei
Jelle Eikhout
Ruud G H van Leeuwen
Esther Tanck
Florieke Eggermont
The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.
PLoS ONE
title The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.
title_full The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.
title_fullStr The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.
title_full_unstemmed The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.
title_short The effect of variations in CT scan protocol on femoral finite element failure load assessment using phantomless calibration.
title_sort effect of variations in ct scan protocol on femoral finite element failure load assessment using phantomless calibration
url https://doi.org/10.1371/journal.pone.0265524
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