Repeatable calibration of Hounsfield units to mineral density and effect of scanning medium

Computed tomography (CT) is being utilized in orthopaedics and related research to estimate bone strength. These applications benefit from calibration of Hounsfield units to mineral density typical of long bone, up to 1750mg/cm³ . This study describes a method for establishing repeatable calibration of Hounsfield units to density, and determines the effects of imaging medium on calibration accuracy. Four hydroxyapatite standards were imaged in air on 7 occasions over 19 weeks using a helical multi-slice CT scanner. Each standard was scanned 5 times in different media: porcine soft tissue, water, and air. Calibrated densities were highly repeatable (CV<3.5%). No difference in density was observed between water and soft tissue conditions (p>0.08). This work provides a model for determining repeatable scanner-specific density calibration, demonstrates that the linear relationship between Hounsfield units and density extends to values typical of cortical bone, and supports the practice of imaging calibration standards in an environment similar to that of the target bone.