 Solution

A CT number is a dimensionless relative attenuation measure, conventionally $H=1000({\mu }_{\mathrm{CT}}-{\mu }_{\mathrm{water},\mathrm{CT}})/{\mu }_{\mathrm{water},\mathrm{CT}}$. The X-ray spectrum used in computed tomography has an effective energy far below $511\mathrm{keV}$ and is polychromatic. Its photoelectric absorption contribution depends strongly on composition, whereas water and soft-tissue attenuation at the positron emission tomography energy is mainly Compton scattering. Thus a CT number is neither a $511\mathrm{keV}$ linear attenuation coefficient nor an energy-independent mass attenuation coefficient.

The usual conversion calibrates a piecewise linear or bilinear relation between CT numbers and $\mu (511\mathrm{keV})$. The air–water branch models predominantly density differences in lung and soft tissue; a separate water–bone branch accounts for the different energy dependence of mineralized tissue. The calibration depends on the computed tomography spectrum. After geometric registration, the resulting linear attenuation coefficient map is forward projected along each coincidence line of response to obtain $\exp (\int {\mu }_{511}ds)$. If a mass coefficient is stored, its conversion to a linear coefficient must also include mass density. Unusual high-atomic-number materials can violate the simple tissue calibration, so the conversion is a physical material model, not a universal arithmetic rescaling.^[ref][ref]