Advances in Environmental Biology, 10(10) October 2016, Pages: 131-138

AENSI Journals

Advances in Environmental Biology

ISSN-1995-0756

EISSN-1998-1066

Journal home page: http://www.aensiweb.com/AEB/

Evaluation of the attenuation values of polyethylene

as a tissue equivalent of human thyroid for dosimetry
purposes using single-energy and dual-energy
computed tomography
1Moayyad
1
2

Alssabbagh, 1,2Abd Aziz Tajuddin, 1Mahayuddin bin Abdul Manap, 1Rafidah Zainon

Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam 13200 Kepala Batas, Pinang, Malaysia
School of Physics, Universiti Sains Malaysia, 11800 Pinang, Malaysia

Address for Correspondence:

Moayyad Alssabbagh, Universiti Sains Malaysia, Advanced Medical and Dental Institute, Oncological and Radiological Sciences
Cluster, Bertam 13200 Kepala Batas, Penang, Malaysia.
E-mail: sabmomo75@gmail.com
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Received 28 August 2016; Accepted 18 October 2016; Available online 22 October 2016

ABSTRACT
Background: Computed tomography scan (CT) measures the attenuation values to differentiate different body tissues, where the attenuation
properties are wildly used in radiation dosimetry to compare different tissue equivalent materials. Objective: The aim of this study is to
examine a fast and simple method to obtain the attenuation values of a tissue equivalent material for dosimetry purposes using SingleEnergy and Dual-Energy CT. Results: A fabricated polyethylene paediatric thyroid phantom was scanned using SECT and DECT, where
auto-parameters that provided by the machine were applied. The CT numbers were evaluated and the mass attenuation coefficients of the
polyethylene were obtained at each applied energy for both single-energy and dual-energy modes. The experiment was repeated at a fixed
parameter of 300 mAs and slice width of 5mm for both scanning modes. The results were compared with the theoretical attenuation values
of the polyethylene and the thyroid that published in National Institute of Standards and Technology (NIST) tables. The mean differences
between the obtained attenuation values of polyethylene from both scanning modes and the values of thyroid show insignificant difference.
The mean and the standard deviation of the ratios between the attenuation values of the phantom material from the NIST, SECT and DECT
and the thyroid were very close to 1, which indicates that the polyethylene has similar attenuation properties as the thyroid tissue. The t-test
results show no significant difference between the measured attenuation coefficients at fixed parameters and the automatic parameters.
Conclusion: Both SECT and DECT show perfectly match with the NISTs values for polyethylene and human thyroid, where no significant
effect on the CT numbers have been seen when changing the current and slice width. The CT scan can be used as a fast and simple method
to determine the mass attenuation coefficients of a phantom material, which could be used as a new method to validate most of phantom
materials.

KEYWORDS: Attenuation value, Dual-energy, Single-energy, CT, Thyroid, Phantom

INTRODUATION
The Computed Tomography (CT) scanning has become very common nowadays, where the produced
images of CT have been enhanced over the years, leading to shortened scanning time and lowered dosage for
patients [1]. The CT numbers are measured in the Hounsfield Unit (HU), which are essential to differentiate
between the different tissues in the body by evaluating their attenuation values [2]. However, the accuracy of CT
numbers limits the range of applications carried out by CT scanners [3].
For the dual-energy CT (DECT), two different energies with high and low kV are used to produce two
different helical resolution images that merge into one image. This hybrid image leads to an enhanced description
of different diagnostic diseases as well as a lower exposure time for scanning the patient [4].

Copyright 2016 by authors and Copyright, American-Eurasian Network for Scientific Information (AENSI Publication).

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The DECT machine uses linear blending functions to reconstruct the output images into three separated
images: low energy, high energy and the fused images from these two energies. This reconstruction method use a
composition ratio for the images from the low and the high energy. The ratio can be changed by the utilized
software in the machine according to the observer preferences.
DECT is able to process the material density images, which also known as material decomposition images.
In addition the DECT can perform the routine scanning images that produced by the SECT. We used Siemens CT
scan in this study, which able to create blended images by mixing the images data set produced from 80 kV and
140 kV.
Monochromatic or mono-energetic images are used to produce images at a single energy level, which vary
from 40 keV to 140 keV in diagnostic range. Generally, SECT produce polychromatic images. The filtration and
using of the half-value layer (HVL) to determine the effective energy or the mono-energy level is required for
more attenuation measurements. In this research, the effective energy produced from the tube x-ray after applying
the accurate the half value layer that provided from the manufacturer was used. The benefit of using the
monochromatic energies is providing more details in the images, such as reducing the image noise at intermediate
mono-energy level. It also used to reduce the metal implants artifacts when applying high mono-energetic level
[4].
In this study, 0.3 weighting factor was used in the reconstruction method of the DECT machine, which
means that 30 % of the information of the fused image comes from the 80 kV image and 70 % from the 140 kV
image. The contrast in the 80 kV image is higher than the 140 kV as well as the noise. One of the methods to
lower the noise and provide a good contrast is to increase the weighting factor for the 140 kV [5].
Balancing the noise and the contrast in the 80 kV and 140 kV by changing the weighting factor will provide
a better discrimination of the anatomical structures, where the quality of the fused image is simulated and
equivalent to the image obtained at 120 kV [610].
The attenuation of penetrated photons through unit mass per unit area of a matter is defined as the mass
attenuation coefficient (/) that highly relies on the density and the atomic number of the material. The mass
attenuation coefficient is wildly used in many radiation fields such as radiation dosimetry to compare different
tissue equivalent materials [11,12].
The linear attenuation coefficient () is affected strongly by the energy of photons, which change along
their paths inside the matter. The density () of the scanned target is proportional to the linear attenuation values
that contribute to produce more informative CT images [13]. As stated in BeerLamberts law in equation (1),
an X-ray beam can be attenuated when it traversed through a thickness (x) of the material [14].
(1)
Based on the equation above, I and Io are the transmitted and incident intensities of the photons, respectively.
The linear attenuation coefficient can then be derived from equation (1):
(2)
The CT numbers represent the mean of all attenuation values located in one voxel layer laid out in a greyshaded scale. The Hounsfield Unit (HU) is linked directly to the attenuation value and the applied energy, at any
effective energy used in the CT scanner [15]. The CT numbers describe the relation between the linear
attenuation coefficient of water (w) and material (m) at a certain energy that represents the mean of all
attenuation values in a specific area [16] and can be given by:
(4)
The value of m is determined by:
(5)
The mass attenuation coefficient (m/) can be obtained by dividing the linear attenuation coefficient of the
material (m) by its density (). The attenuation values of different tissue-equivalent materials that are used in
different phantoms, such as PMMA, Polyethylene, Paraffin wax, Polystyrene and Rossi gel are collected by
International Commission on Radiation Units & Measurements, ICRU-44 in the range of 1 KeV - 50 MeV of Xray energy [17,18].
From the definition, CT numbers are 0 HU for water, -1000 HU for air and from +400 to +1000 HU for
bone. CT scanners nowadays have a wider range of CT numbers, even up to 4000 HU [19]. For the purpose of

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quality assurance, the CT numbers of water are somehow flexible under certain authorities of manufacturers and
countries. For instance, the HU of water falls within 4 as stated in the European Guidelines and Health
Canadas Safety Code No.35, and within 3 according to the General Electric Healthcare (GE) [20]. In general,
the CT numbers change according to the attenuation values of the scanned material.
From literatures, the CT numbers of the soft tissue ranging from 0 -100 HU [21]. Some references place the
HU of the soft tissue between -300 HU and -100 HU [22,23]. In general the HU of the soft tissue varies
according to the organ under test. The measured CT numbers for different equivalent tissue materials, such as
polycarbonate, polyurethane, polypropylene, polyethylene and PMMA showed HU values outside the range of
the soft tissue [21]. The elementary compositions of these materials are playing a rule in showing different CT
numbers [24]. However, their attenuation values show a good agreement with the soft tissue. The attenuation
values of soft tissues are slightly close to the water [25], although their CT numbers are different than the
equivalent substitute tissue (ex. PMMA) but they have closer match in the attenuation values terms. Increasing
the kVp increase the HU value of polyethylene and PMMA.
In this study, two different CT techniques (single-energy and dual-energy imaging) were used to evaluate
the polyethylene to simulate the thyroid tissue in terms of their mass attenuation coefficients. The results were
compared with the values published in National Institute of Standards and Technology (NIST). The X-ray
energies of 10 to 150 keV were taken into account as the most of the diagnostic radiology fall within this range.
MATERIALS AND METHODS
Single-source dual-energy CT (Somatom Definition; Siemens AG, Germany) capable of producing singleenergy and dual-energy imaging was used. Polyethylene was used to fabricate a paediatric thyroid phantom that
can be inserted into a polymethylmethacrylate (PPMA) container to simulate the position of the thyroid inside the
neck as shown in Figure 1. The appropriate size and dimensions of the thyroid phantom were chosen according to
several studies [2629]. A lobe width of 1.2 cm and height of 2.5 cm were selected for the thyroid phantom.
Average diameter of 10 cm was decided for the neck of females and males of ages ranging from 9 to 10 years old.
Following this, the container filled with water and the fabricated phantom material were scanned with both
single-energy and dual-energy modes as shown in Figure 2. The tube voltage was set at 70, 80, 100, 120 and 140
kV for the single-energy mode and only two voltages of 80 kV and 140 kV were set for the dual-energy mode.
The tubes current modulation CARE Dose 4D was applied and the slice width was automatically set by the
machine at 1.5 mm.
The experiment was repeated to study the effect of fixing parameters on the CT numbers, where the current
and slice width were fixed at 300 mAs and 5 mm respectively for both scanning modes.

Fig. 1: (a) The fabricated paediatric thyroid phantom (b) The container (neck) filled with water and the thyroid
phantom positioned inside it.

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Fig. 2: The position of the fabricated phantom in the CT scanner.

The CT images were analysed in DICOM format using the Weasis Medical Viewer Free Software v.1.2.7, a
Java Web Start application developed by Nicolas Roduit [30]. The region of interest of the thyroid phantom in
the CT images was selected in each scanned slice as shown in Figure 3 and the CT numbers were evaluated. The
mean value of the CT numbers and the standard deviation were then taken for both single-energy and dualenergy modes at each applied energy.

Fig. 3: Evaluation of the CT numbers of the fabricated thyroid phantom from each scanned slice.
RESULTS AND DISCUSSION
As described in the introduction, the DECT is able to provide a detailed material images according to a mass
attenuation coefficient of a specific material, which its atomic number (Z) is playing a rule as well. The
importance of material detailed images is providing a qualitative and quantitative information about the material
composition as well as the distribution of the contrast media (Patino et al. 2016).

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The images from the DECT were reconstructed by the CT scan software to three images sets: 80 kV, 140 kV
and the fused image of these two energies with weighting factor of 30 % for 80 kV and 70 % for 140 kV. By
using this ratio, the equivalent of the fused images from DECT are simulated by the quality of the images taken
from SECT at 120 kV [4].
The mean differences of the evaluated CT numbers of the phantom material from DECT and SECT imaging
at the same applied voltages show insignificant values as shown in table 1 and figure 4, where the differences
are only -4.18 (4.32%) HU at an energy of 80 kV from both modes and 2.61 (3.93%) HU and 4.02 (6.17%) HU
at energies of 120 kV and 140 kV respectively.
Table 1: The measured CT numbers from the DECT and SECT
SECT
kV
CT No. (HU)
STD ()
70
-118.22
17.98
80
-96.73
14.57
100
-76.44
9.52
120
-66.33
8.95
140
-58.22
7.36

DECT
CT No. (HU)
-92.55
-68.94
-62.24

STD ()
7.96
5.63
7.62

Difference
-4.18
2.61
4.02

The linear attenuation coefficients of the phantom material (polyethylene) were calculated using equation
(5). The mass attenuation coefficients of polyethylene (p/) were then calculated by dividing the obtained
linear attenuation coefficients by its density () (0.92 g/cm2), which provided by the supplier, for each applied
voltage in DECT and SECT.
To obtain the mass attenuation coefficients of the thyroid, the online XCOM photon cross-section database
software [31] was used, where the effective energy in KeV that provided from the manufacturer for each voltage
on the CT scan was applied. The obtained mass attenuation coefficients of polyethylene (p/) for both imaging
modes and the NISTs values of the thyroid and polyethylene are listed in table 2.
The mean difference between the obtained mass attenuation coefficients of the polyethylene from the
DECT and SECT and its values from NIST was less than 0.03, slightly higher than the values of NIST. This
shows very small difference and so it can be neglected. In contrast, the mean difference between the obtained
attenuation values of the scanned polyethylene and the values of thyroid was slightly lower than the NISTs
values with less than -0.02 for DECT and SECT, which both show insignificant difference as well.
Furthermore, the ratios between the obtained mass attenuation coefficients of the polyethylene from both
scanning modes and the thyroid attenuation values were calculated. The mean and the standard deviation of the
ratios between the attenuation values of the phantom material from the NIST, SECT and DECT and the thyroid
were 0.89 0.05, 0.96 0.04 and 0.97 0.03 respectively. The results show that all values are very close to 1,
which indicates that the polyethylene has similar attenuation properties as the thyroid tissue for this range of the
x-ray energy, even though the CT numbers are different. The calculated HU for thyroid is ranging from 36
111.9 [32,33] and the measured mean CT numbers for thyroid ranging from 118 HU 125 HU [34,35].
Obviously, the difference between the CT numbers of the thyroid and the polyethylene is significant, where the
HU of the polyethylene ranging from -75 HU to -135 HU [20,36,37]. But for dosimetry purposes the most
physical property that widely used to investigate the equivalence of tissues is the mass attenuation coefficient
(/).
Table 2: The mass attenuation coefficient from both scanning modes compared with the values of NIST for thyroid and polyethylene
PE (SECT)
PE (DECT)
Mean difference
NIST ( /)
PE/
PE/
kV
KeV
PE
Thyroid
PE (scan & NIST)
PE (scan) & Thyroid (NIST)
70
43.57
0.2491
0.2207
0.2692
80
46.00
0.2424
0.2401
0.2160
0.2570
0.024
-0.017
100
51.78
0.2240
0.2064
0.2324
120
56.23
0.2170
0.2164
0.2013
0.2211
0.015
-0.004
140
61.45
0.2091
0.2082
0.1959
0.2096
0.013
-0.001

The experiment was repeated at fixed parameters, where the current and slice width were fixed at 300 mAs
and 5 mm respectively, for both single-energy and dual-energy modes. No significant differences were seen
from the results of the CT numbers from both modes as shown in figure 4. In addition, the t-test for two-tails
was used to compare the measured CT numbers at fixed parameters and the automatic parameters from the
earlier experiment for both scanning modes. No significant difference was found for the both modes between
the two experiments, where all p-values (t-test p-value > 0.05) were higher than 0.05, in which the p-value was
0.67 for the SECT and 0.95 for the DECT from both experiments.
The mass attenuation coefficients obtained from both experiments (fixed and auto-parameters) were very
similar and no significant difference was found when compared with the values of NIST as illustrated in Figure
5.

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Fig. 4: The CT numbers obtained from SECT and DECT.

Fig. 5: The mass attenuation coefficient of polyethylene obtained from DECT and SECT (Fixed and Auto)
compared with the values of NIST.
Conclusion:
In spite of the fact that the Dual energy CT proposes many applications and possibilities that might not offers
by the traditional single energy CT, such as increasing the detection of lesion, reducing the artifacts as well as
reducing the radiation dose, the CT numbers in this study show insignificant difference between the two scanning
modes (DECT and SECT). In this study, the CT numbers were used to calculate the mass attenuation coefficient
of the polyethylene. It is seen that the phantom material (polyethylene) shows a trend in increasing CT numbers
with the increase of applied voltage on all modes, in which the attenuation of the penetrated photons decreases
with the increase in the energy of photons, thus raising the values of the measured CT numbers.
From the results the polyethylene and the thyroid show large difference in CT numbers. However, the
polyethylene has similar attenuation properties with the thyroid tissue for this energy range of x-ray. This is due
to the difference of densities of the polyethylene and the thyroid. The decrease in linear attenuation coefficient
(PE) of polyethylene was compensated by its lower density (0.92 g/cm2) compared to thyroid density (1.05
g/cm2).
According to the used weighing factor in this study to obtain the fused image, it is assumed that the quality
of the fused image corresponds to an image taken at 120 kV. It was seen that there is no significant difference
when comparing the HU value or the mass attenuation coefficients of the phantom material from the SECT
image at 120 kV and the fused image from the DECT. The change in current and slice width have no significant

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effect on the CT numbers, while the CT numbers are increased by the increasing the energy of the incident
photons.
The conventional method to determine the mass attenuation coefficients of any phantom material is to
analyse its elemental composition. This is to conclude, both single-energy and dual-energy CT can be used as a
simple and fast method to determine the mass attenuation coefficients of the phantom material, where the results
show very close match with the attenuation values of the thyroid obtained from the NISTs tables. Furthermore,
the fused image from the dual-energy CT can be used as a new method to obtain the mass attenuation
coefficients, since it seems to be a perfect match with the NIST values.
Contribution to knowledge:
Previous researches has demonstrated that the conventional method to evaluate the tissue equivalent
materials is by using their elemental composition, effective atomic number and the mass density .In contrast, the
current research is the first attempt to study the efficacy of using the CT numbers to evaluate the mass
attenuation coefficients for phantom verification purposes. We believe that this study will contribute effectively
to develop and improve the methodology of evaluation of different phantoms materials using a simple and fast
method.
ACKNOWLEDGEMENT
The authors would like to thank Ministry of Higher Education of Malaysia for funding this work. We also
would like to thank and show our gratitude to the radiographers of the imaging department in AMDI, Universiti
Sains Malaysia, who provided insight and expertise that greatly assisted this research
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