Selection of X-ray Tube Settings for Relative Bone Density Quantification in the Knee Joint of Cats Using Computed Digital Absorptiometry

Abstract

Bone mineral density (BMD) varies with aging and both systemic and local diseases; however, such evidence is lacking in feline medicine. This may be due to the need for general anesthesia in cats for direct BMD measurements using dual-energy X-ray absorptiometry (DXA) or quantitative computed tomography (QCT). In this study, computed digital absorptiometry (CDA), an indirect relative BMD-measuring method, was optimized to select an X-ray tube setting for the quantitative assessment of the feline knee joint. The knee joints of nine cats were radiographically imaged and processed using the CDA method with an aluminum density standard and five X-ray tube settings (from 50 to 80 kV; between 1.2 and 12 mAs). The reference attenuation of the X-ray beam for ten steps (S1–S10) of the density standard was recorded in Hounsfield units (HU), compared between X-ray tube settings, and used to determine the ranges of relative density applied for radiograph decomposition. The relative density decreased (p < 0.0001) with an increase in kV and dispersed with an increase in mAs. Then, the percentage of color pixels (%color pixels), representing ranges of relative density, was compared among S1–S10 and used for the recognition of background artifacts. The %color pixels was the highest for low steps and the lowest for high steps (p < 0.0001), regardless of X-ray tube settings. The X-ray tube setting was considered the most beneficial when it effectively covered the lowest possible HU ranges without inducing background artifacts. In conclusion, for further clinical application of the CDA method for quantitative research on knee joint OA in cats, 60 kV and 1.2 mAs settings are recommended.