Artificial High- and Low-density Materials in Bone Mineral Densitometry Using Dual-energy X-ray Absorptiometry: A GATE Monte Carlo Simulation of "Black-hole" Artifact.

Objective: The objective of the study was to evaluate the effect of artificial high- and low-density materials on Bone mineral density (BMD)scans in dual-energy X-ray absorptiometry (DXA) method and emergence of black-hole artifact through GATE Monte Carlo simulation.

Materials and methods: GATE Monte Carlo code was utilized to simulate the artifact encountered in clinical scans acquired by HOLOGIC^® bone densitometer. Two simplified phantoms were designed. The first one was a rectangular box with six smaller cubes inside and the second one was a body torso. Materials of cubes were spine bone, polymethyl methacrylate (PMMA), barium sulfate suspension in water, stainless steel, titanium alloy, and gold. The torso phantom contained objects of 5 vertebrae, bowel and 3 small spherical objects near the surface of the torso as piercing objects on the abdominal wall, each overlying the vertebrae. Using 100 and 140 kVp, spectral X-rays were generated to simulate DXA. For both phantoms, two simulations were carried out. The pair of projections acquired for each phantom were then subtracted and analyzed by curve fitting techniques.

Results: Except for spine bone, in which radio-opacity decreases with increasing spectral X-ray energy (from 100 to 140 kVp), other squares exhibit little changes over different energies. PMMA shows consistently very low radio-opacity. Four other materials (barium sulfate in water, stainless steel alloy, titanium alloy, and gold), all attenuate the X-ray photons substantially. Except for spine bone, other materials are barely noticeable in pairwise subtracted images. In torso phantom, piercing objects are visualized as "holes" in vertebrae.

Conclusion: Both artificial high- and low-density materials, compared to bone, are eliminated during the subtraction of dual-energy X-ray profiles and therefore, can create black-hole artifact.