Spectral Hounsfield units: a new radiological concept

Objective Computed tomography (CT) uses radiographical density to depict different materials; although different elements have different absorption fingerprints across the range of diagnostic X-ray energies, this spectral absorption information is lost in conventional CT. The recent development of dual energy CT (DECT) allows extraction of this information to a useful but limited extent. However, the advent of new photon counting chips that have energy resolution capabilities has put multi-energy or spectral CT (SCT) on the clinical horizon. Methods This paper uses a prototype SCT system to demonstrate how CT density measurements vary with kilovoltage. Results While radiologists learn about linear attenuation curves during radiology training, they do not usually need a detailed understanding of this phenomenon in their clinical practice. However SCT requires a paradigm shift in how radiologists think about CT density. Conclusion Because radiologists are already familiar with the Hounsfield Unit (HU), it is proposed that a modified HU be used that includes the mean energy used to obtain the image, as a conceptual bridge between conventional CT and SCT. A suggested format would be: HU keV . Key Points • Spectral computed tomography uses K-edge and slope effects to identify element signatures . • New visualisation tools will be required to efficiently display spectral CT information . • This paper demonstrates HU variation with keV using the Medipix3 chip . • HU keV is a suggested format when stating spectral HU measurements .