Ecr2017 C-1136

Estimation of the PMMA phantom thickness for simulating
a human body by using the µx-map created from the CT

images
Poster No.: C-1136

Congress: ECR 2017
Type: Scientific Exhibit
Authors: T. Inoue, Y. Takeda, K. Yoshitomi, A. Kurozumi, R. Matsuura, S.
Tahara; Okayama/JP
Keywords: Physics, CT, Mediastinum, Lung, Image verification
DOI: 10.1594/ecr2017/C-1136
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Page 1 of 23
Aims and objectives
When the X-ray system changes from old device to new device or the facility introduces
a new X-ray device, usually it is necessary to evaluate the performance of the device by
comparing between new device and previous one. One method of evaluating the device
is a test using contrast-detail phantom [1-3]. In this test, the polymethylmethacrylate
(PMMA) phantom is often used to simulate scattering of X-rays in a human body. Accurate
human body simulation must carry out in order to avoid the possibility of consideration of
the erroneous radiography conditions that deviating from the clinical state. In this study,
2
by dividing the patient data from their BMI (Body Mass Index: kg/m ) into a lean, standard
or obese body type, it possible to simulate each body type by using the PMMA phantom
thickness corresponding to each body type. This data has not been reported and we can
simulate more accurate radiography conditions by using this data.
The purpose of this study is, especially focus on the chest, to estimation of the PMMA
phantom thickness to simulate a human body for lung field and mediastinum in each
body type.
Fig. 1: How much the PMMA phantom thickness is required?

References: Department of Medical Technology, Okayama University - Okayama/JP
Page 2 of 23
Images for this section:
Fig. 1: How much the PMMA phantom thickness is required?
© Department of Medical Technology, Okayama University - Okayama/JP
Page 3 of 23
Methods and materials
#Subject selection
The data of this study was based on the CT examination performed at Okayama
University Hospital, and this study was approved by the institutional review board.
The objects were non-contrast chest CT examination performed at Okayama University

Hospital for adults over 20 years old except for including motion artifact, inappropriate
body position, inserting metal such as a coil into the body, and including other factor that
prevent accurate measurement. Additionally, the patients who have undergone surgery
or have anatomically difference such as visceral inversion and the patients with some
diseases that could disturb the accurate measurement were excluded. Table 1 shows
the study population of each body type and sex in this study. We defined BMI<18.5,
18.5#BMI<25 and 25#BMI as lean, standard and obese respectively by using the BMI
classification advocated by WHO as a reference.
Table 1: Body types and sex population

#create method of the µx-map
Image reconstruction was performed from the raw data of the patient who received
the non-contrast chest CT examination and both slice thickness and slice interval
were 1 mm with reconstruction function FC15 (Aquilion ONE:TOSHIBA). The linear
attenuation coefficient was calculated from CT number in one transverse image and a
linear attenuation coefficient distribution chart (µ-map) was created. The µ-map bar was
created by addition to the anteroposterior direction in the µ-map. We performed the same
operation for all CT images. The µ-mapAP which observed the patient from the front
was created by arranging all µ-map bars in the body axis direction. The µx-mapAP was
Page 4 of 23
created by multiplying the µ-mapAP by the pixel size. The color mapping was used to
easy understand for the degree of attenuation. The red color indicates a greater degree
of attenuation, and the blue color indicates a little degree of attenuation.
Fig. 2: Flow chart of the µ-mapAP. The µx-mapAP was created in the following
steps ① to #. #Converted the linear attenuation distribution chart. #Added in the
anteroposterior direction and performed the same operation in all of CT images.
#Arranged in the body axis direction. #The µx-map = the µ-map*the pixel size.
#calculation principle
In the case of (a) in Fig.6, when the linear attenuation coefficient and the size of each
substance were defined, the transmitted dose I3 is able to represent by the incident dose
I0 as shown in equation (1).
Page 5 of 23
Fig. 3: equation (1)
When equation (1) replaced with a CT image are considered ((b) in Fig.3), the size of each
substance can be regarded as pixel size d. As a result, equation (1) can be equation (2).

When the sum of attenuation coefficients is µ, equation (2) can be equation (3).

Namely, when the linear attenuation coefficient of each pixel is added in the CT image,
the results of addition can be regarded as the substance which has a thickness of the
pixel size d and a sum linear attenuation coefficient µ.
Page 6 of 23
Fig. 6: Calculation of attenuation coefficient (µ) by thinking procedure of the X-ray
attenuation. (a) Attenuation of the radiation when transmitting continuous substance.
(b) The linear attenuation coefficient of each voxel in the CT image.
In the one transverse image, the linear attenuation coefficients are added in the
anteroposterior direction in each column and the linear attenuation coefficient bar was
created. The µ-mapAP when observing the patient from the front is completed by carrying
out same processing in all CT images and arranging them in the body axis direction. The
µx-mapAP was created by multiplying the µ-mapAP by the pixel size. The equation (4) was
obtained by differentiating the equation (3). The negative sign in equation (4) means that
the radiation attenuates as it passes through the substance, and equation (4) shows the
amount of radiation attenuated when passing through the differential distance dx.
Page 7 of 23
The mean value obtained by setting the ROI in the µx-mapAP corresponds to the right
side of equation (4). The linear attenuation coefficient of the µ-mapAP and the PMMA
phantom are defined as µAP and µP respectively, and the PMMA phantom thickness is
defined as dP. When the attenuation in a human body is equal to the attenuation in the
PMMA phantom, equation (5) holds.

Solving equation (5) obtains equation (6).
Page 8 of 23
The PMMA phantom thickness that has the same degree of attenuation as the attenuated
radiation dose in a human body is calculated from equation (6). The attenuation
coefficient of the PMMA phantom was also obtained by using CT examination.
#method of measurement
Four square ROI were created on the µx-mapAP (Fig.10). Mean values within each ROI
were measured and the average value of measurement results of both lung fields was
adopted as lung field value. The ROI# was set to determine thorax size and to suppress
variation in measurement. The ROI#,# and # sizes and positions were determined from
the ROI#.
Page 9 of 23
Fig. 10: Four ROI positions. The ROI#:Thorax. The ROI#,#:Lung field. The
ROI#:Mediastinum.
#Statistical analysis
F-test was conducted to investigate the variance of the measurement results in each
body type and each body part with sex as a factor. The measurement results between
male and female in each body type and each body part were statistically analyzed using
Welch test.
Page 10 of 23
Table 1: Body types and sex population
Fig. 2: Flow chart of the µ-mapAP. The µx-mapAP was created in the following steps #
to #. #Converted the linear attenuation distribution chart. #Added in the anteroposterior
direction and performed the same operation in all of CT images. #Arranged in the body
axis direction. #The µx-map = the µ-map*the pixel size.
Page 11 of 23
Page 12 of 23
Fig. 6: Calculation of attenuation coefficient (µ) by thinking procedure of the X-ray
attenuation. (a) Attenuation of the radiation when transmitting continuous substance. (b)
The linear attenuation coefficient of each voxel in the CT image.
Page 13 of 23
Page 14 of 23
Fig. 10: Four ROI positions. The ROI#:Thorax. The ROI#,#:Lung field. The
ROI#:Mediastinum.
Page 15 of 23
Results
#Results
The measurement results for each body type and each body part were shown in Table 2,
Fig.11, Fig.12 and Fig.13. In the table.2, due to the PMMA phantom specifications, the
measurement results were rounded off a whole number.
Table 2: The measurement results of each body type

Fig. 11: Results of the PMMA phantom thickness. (a)The PMMA phantom thickness in
male. (b)The PMMA phantom thickness in female.
Page 16 of 23
Fig. 12: Scatter plots between the BMI and the PMMA phantom thickness in male.
(a)The mediastinum. (b)The lung.
Fig. 13: Scatter plots between the BMI and the PMMA phantom thickness in female.
Statistical analysis was performed on the results. As a result of F-test, male and female
were heteroscredastic in all body types and parts. When the Welch test was applied as
statistical analysis to the difference between male and female from the result of the F-
test, there was a significant difference in all body types in the result of the mediastinum.
However, in the result of the lung, there was no significant difference in all body types.
Normally, in a test using a CDRAD phantom, a scatterer is placed before and after the
CDRAD phantom [2]. Therefore, when the CDRAD phantom was used with the PMMA
Page 17 of 23
phantom, it is considered that the PMMA phantom is arranged half before and after the
CDRAD phantom.
#Discussion
This method of this study has several limitations such as the different of the effective
energy between the general imaging device and the CT device. Since the effective energy
of each device is different, even when the same substance is photographed, each linear
attenuation coefficient is different [4]. Therefore, if we apply the PMMA phantom thickness
which estimated from the linear attenuation coefficient at the CT device, to the general
imaging device with different effective energy as it is, there is a possibility of mistaking
the evaluation. However, it is reported that the variation due to the effective energy of
the line attenuation coefficient of water and soft tissues is smaller than that of bone or
iodine [5]. Furthermore, the difference in effective energy between each device is several
keV. For this reason, although there was a difference in effective energy between the
general imaging device and the CT device, it is considered that the influence on the
PMMA phantom thickness calculated in this study was small.
The effective energy of the CT device in this study was approximately 55 keV.
Page 18 of 23
Table 2: The measurement results of each body type
Fig. 11: Results of the PMMA phantom thickness. (a)The PMMA phantom thickness in
male. (b)The PMMA phantom thickness in female.
Page 19 of 23
Fig. 12: Scatter plots between the BMI and the PMMA phantom thickness in male. (a)The
mediastinum. (b)The lung.
Fig. 13: Scatter plots between the BMI and the PMMA phantom thickness in female.
Page 20 of 23
Conclusion
The PMMA phantom thickness which simulated each body type and each body part was
able to be estimated by using the µx-map in this study.
Additionally, when the addition direction is set as the transverse direction at the µ-map,
the µx-map when observing the patient from the side can be calculate and we can
simulate a human body when observing the patient from the side. The µx-map has various
possibilities for a human body simulation.
Page 21 of 23
Personal information
Tomohiro Inoue BS, Graduate school of Health, Okayama University, Okayama

University, Okayama-shi, Japan;
Medical Technology Department, Division of Radiology, Okayama University Hospital,

Okayama-shi, Japan;
inoue-tmhr@okayama-u.ac.jp
Yoshihiro Takeda PhD, Graduate school of Health, Okayama University, Okayama-shi,

Japan;
ytakeda@md.okayama-u.ac.jp
Keisuke Yoshitomi MHSc, Medical Technology Department, Division of Radiology,

Okayama University Hospital, Okayama-shi, Japan;
k_yoshitomi@okayama-u.ac.jp
Akira Kurozumi BS, Graduate school of Health, Okayama University, Okayama

University, Okayama-shi, Japan;
Medical Technology Department, Division of Radiology, Okayama University Hospital,

Okayama-shi, Japan;
kurozumi@cc.okayama-u.ac.jp
Ryutaro Matsuura MHSc, Department of Health Science, Okayama University,

Okayama-shi, Japan;
matsuu-r@cc.okayama-u.ac.jp
Seiji Tahara BS, Medical Technology Department, Division of Radiology, Okayama

University Hospital, Okayama-shi, Japan;
stahara@hp.okayama-u.ac.jp
Page 22 of 23
References
1. Geijer, H., Beckman, K. W., Andersson, T., & Persliden, J. (2001). Image quality vs
radiation dose for a flat-panel amorphous silicon detector: a phantom study. European
radiology, 11(9), 1704-1709.
2 Neitzel, U., Boehm, A., & Maack, I. (2000). Comparison of low-contrast detail
detectability with five different conventional and digital radiographic imaging systems. In
Medical Imaging 2000 (pp. 216-223). International Society for Optics and Photonics.
3. Norrman, E., Gårdestig, M., Persliden, J., & Geijer, H. (2005). A clinical evaluation of
the image quality computer program, CoCIQ. Journal of digital imaging, 18(2), 138-144.
4. Brooks, R. A., & Di Chiro, G. (1976). Principles of computer assisted tomography (CAT)
in radiographic and radioisotopic imaging. Physics in medicine and biology, 21(5), 689.
5. Huda, W., Scalzetti, E. M., & Levin, G. (2000). Technique factors and image quality as
functions of patient weight at abdominal CT 1. Radiology, 217(2), 430-435.
Page 23 of 23

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Ecr2017 C-1136

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Estimation of the PMMA phantom thickness for simulating

a human body by using the µx-map created from the CT

Poster No.: C-1136

Fig. 1: How much the PMMA phantom thickness is required?

Fig. 1: How much the PMMA phantom thickness is required?

© Department of Medical Technology, Okayama University - Okayama/JP

The objects were non-contrast chest CT examination performed at Okayama University

Table 1: Body types and sex population

#create method of the µx-map

Fig. 4: equation (2)

Fig. 5: equation (3)

Fig. 8: equation (5)

Solving equation (5) obtains equation (6).

Table 1: Body types and sex population

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

Fig. 4: equation (2)

© Department of Medical Technology, Okayama University - Okayama/JP

Fig. 5: equation (3)

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

Fig. 7: equation (4)

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

Fig. 9: equation (6)

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

Table 2: The measurement results of each body type

Table 2: The measurement results of each body type

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

© Department of Medical Technology, Okayama University - Okayama/JP

Tomohiro Inoue BS, Graduate school of Health, Okayama University, Okayama

Medical Technology Department, Division of Radiology, Okayama University Hospital,

Yoshihiro Takeda PhD, Graduate school of Health, Okayama University, Okayama-shi,

Keisuke Yoshitomi MHSc, Medical Technology Department, Division of Radiology,

Akira Kurozumi BS, Graduate school of Health, Okayama University, Okayama

Medical Technology Department, Division of Radiology, Okayama University Hospital,

Ryutaro Matsuura MHSc, Department of Health Science, Okayama University,

Seiji Tahara BS, Medical Technology Department, Division of Radiology, Okayama

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