Optimization of HU threshold for coronary artery calcium scans reconstructed at 0.5-mm slice thickness using iterative reconstruction

J Appl Clin Med Phys. 2020 Feb;21(2):111-120. doi: 10.1002/acm2.12806. Epub 2019 Dec 30.


Purpose: This work investigated the simultaneous influence of tube voltage, tube current, body size, and HU threshold on calcium scoring reconstructed at 0.5-mm slice thickness using iterative reconstruction (IR) through multivariate analysis. Regression results were used to optimize the HU threshold to calibrate the resulting Agatston scores to be consistent with those obtained from the conventional protocol.

Methods: A thorax phantom set simulating three different body sizes was used in this study. A total of 14 coronary artery calcium (CAC) protocols were studied, including 1 conventional protocol reconstructed at 3-mm slice thickness, 1 FBP protocol, and 12 statistical IR protocols (3 kVp values*4 SD values) reconstructed at 0.5-mm slice thickness. Three HU thresholds were applied for calcium identification, including 130, 150, and 170 HU. A multiple linear regression method was used to analyze the impact of kVp, SD, body size, and HU threshold on the Agatston scores of three calcification densities for IR-reconstructed CAC scans acquired with 0.5-mm slice thickness.

Results: Each regression relationship has R2 larger than 0.80, indicating a good fit to the data. Based on the regression models, the HU thresholds as a function of SD estimated to ensure the quantification accuracy of calcium scores for 120-, 100-, and 80-kVp CAC scans reconstructed at 0.5-mm slice thickness using IR for three different body sizes were proposed. Our results indicate that the HU threshold should be adjusted according to the imaging condition, whereas a 130-HU threshold is appropriate for 120-kVp CAC scans acquired with SD = 55 for body size of 24.5 cm.

Conclusion: The optimized HU thresholds were proposed for CAC scans reconstructed at 0.5-mm slice thickness using IR. Our study results may provide a potential strategy to improve the reliability of calcium scoring by reducing partial volume effect while keeping radiation dose as low as reasonably achievable.

Keywords: Agatston score; coronary artery calcification; iterative reconstruction; protocol optimization.

MeSH terms

  • Anthropometry
  • Calcinosis / diagnostic imaging*
  • Calcium / analysis
  • Calibration
  • Coronary Angiography
  • Coronary Vessels / diagnostic imaging*
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Multivariate Analysis
  • Phantoms, Imaging
  • Radiation Dosage
  • Radiographic Image Enhancement / methods
  • Radiographic Image Interpretation, Computer-Assisted / methods
  • Radionuclide Imaging
  • Regression Analysis
  • Reproducibility of Results
  • Tomography, X-Ray Computed


  • Calcium