Effects of overlying soft tissue on X-ray fluorescence bone lead measurement uncertainty

The effects of overlying soft tissue on the measurement uncertainty of the in vivo ¹⁰⁹Cd K-shell X-ray fluorescence (XRF) technique were investigated, as applied to the tibia bone site. Experimental measurements were performed on a set of nine leg phantoms of different soft tissue thickness, intended to model the lower leg at mid-tibia. A standard bone phantom made from plaster-of-Paris and having a nominal lead concentration of 25.6 μg Pb per gram was used in all trials. Monte Carlo simulations of the experimental set-up were also performed. Results indicate a strong relation between measurement uncertainty and overlying tissue thickness (OTT) for the XRF bone lead method. In increasing the OTT from 3.2 to 14.6 mm, an increase in average measurement uncertainty by a factor of 2.40 was observed experimentally. Monte Carlo simulations indicated an increase in minimum detectable limit (MDL) by a factor of 2.46 over the same interval. Experimental and Monte Carlo results were generally in strong agreement. For subject screening purposes, direct measurement of soft tissue overlying the tibia is recommended whenever practical.