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Table 1.

Overview of the different scan protocols and the corresponding CT settings.

Standard protocol covers the CT settings that are standard for scans made at the Radiotherapy department of the Radboudumc. All other protocols deviate one setting from the standard protocol.

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Fig 1.

An example of the selected region of interest (left) and the histogram of the Hounsfield units within the region of interest with the peaks for air, fat, and muscle (right).

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Fig 2.

Boundary conditions of the finite element model.

The model was distally fixated by two high stiffness springs, and the load was applied through a cup located on the head of the femur. The figure is with permission adapted from Eggermont et al., Bone, 2020 [11].

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Fig 3.

An example of the trabecular (upper) and cortical (lower) regions of interest including axial views.

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Fig 4.

HU of the trabecular (upper figure) and cortical (lower figure) ROIs. For each femur, the HUs are displayed relative to the standard protocol. The red dashed line indicates 100%.

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Fig 5.

BMD of the trabecular (upper half) and cortical bone (lower half) for phantom (left), air-fat-muscle (middle), and non-patient-specific (right) calibration per protocol. For each femur, the BMD values are displayed relative to the standard protocol. The red dashed line indicates 100%.

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Fig 6.

Correlation between failure loads after phantom and air-fat-muscle calibration and phantom and non-patient-specific calibration.

Solid lines show the best-fit lines for each protocol.

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Fig 7.

Failure load per protocol, per calibration method.

For each femur, the failure loads are displayed relative to the standard protocol. The red dashed line indicates 100%.

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Fig 8.

Slices of the same diaphyseal region from the CT scans of femur 4 (left) and femur 5 (right) with the corresponding HU histograms. Femur 5 shows accumulation of fat in the muscle tissue.

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