The psoas muscle and the erector spinae muscles were segmented bilaterally at the level of L4 over a craniocaudal distance of 10 mm in the axial reformations of the original dose images (Figure 1). Segmentation was performed by using the free open-source software Medical Imaging Interaction Toolkit (MITK, developed by the Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany) by a radiologist with 4 years of experience. Segmentations were superimposed on all low-dose scans. MD was extracted in Hounsfield Units (HU) of each muscle in each scan. Volume weighted mean MD of the right and left psoas and erector spinae muscle was calculated, respectively. A second reader performed segmentation of all included subjects to evaluate the inter-rater reliability of the results.

In this figure representative segmentations are depicted. The level L4 (A) was chosen to perform manual segmentation of the right (1) and left (2) erector spina and the right (3) and left (4) psoas muscle (B).

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