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Selles M, van Osch JAC, Maas M, Boomsma MF, Wellenberg RHH. Advances in metal artifact reduction in CT images: A review of traditional and novel metal artifact reduction techniques. Eur J Radiol 2024; 170:111276. [PMID: 38142571 DOI: 10.1016/j.ejrad.2023.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
Metal artifacts degrade CT image quality, hampering clinical assessment. Numerous metal artifact reduction methods are available to improve the image quality of CT images with metal implants. In this review, an overview of traditional methods is provided including the modification of acquisition and reconstruction parameters, projection-based metal artifact reduction techniques (MAR), dual energy CT (DECT) and the combination of these techniques. Furthermore, the additional value and challenges of novel metal artifact reduction techniques that have been introduced over the past years are discussed such as photon counting CT (PCCT) and deep learning based metal artifact reduction techniques.
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Affiliation(s)
- Mark Selles
- Department of Radiology, Isala, 8025 AB Zwolle, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands.
| | | | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
| | | | - Ruud H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
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2
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Zhao J, Cheng Q, Liu C, Wang Q, Lv Y, Tang Z, Luo Y, Yang H. Optimal combination periprosthetic vasculature visualization and metal artifact reduction by spectral computed tomography using virtual monoenergetic images in total hip arthroplasty. Insights Imaging 2023; 14:181. [PMID: 37880460 PMCID: PMC10600072 DOI: 10.1186/s13244-023-01533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To investigate the optimal parameters of spectral CT for preferably visualizing the periprosthetic vasculature and metal artifact reduction (MAR) in total hip arthroplasty (THA). METHODS A total of 34 THA of 30 patients were retrospectively included. Image reconstructions included conventional image (CI), CI combined with MAR (CIMAR), and virtual monoenergetic images (VMI) combined with MAR (VMIMAR) at 50-120 keV. The attenuation and standard deviation of the vessel and artifact, and the width of artifact were measured. Qualitative scoring was evaluated including the vascular contour, the extent of artifact, and overall diagnostic evaluation. RESULTS The attenuation, noise of the vessel and artifact, and the width of artifact decreased as the energy level increased (p < 0.001). The downtrend was relatively flat at 80-120 keV, and the vascular attenuation dropped to 200 HU at 90 keV. The qualitative rating of vascular contour was significantly higher at CIMAR (3.47) and VMIMAR 60-80 keV (2.82-3.65) compared with CI (2.03) (p ≤ 0.029), and the highest score occurred at 70 and 80 keV (3.65 and 3.56). The score of the extent of artifact was higher at VMIMAR 80 keV than CIMAR (3.53 VS 3.12, p = 0.003). The score of the overall diagnostic evaluation was higher at VMIMAR 70 and 80 keV (3.32 and 3.53, respectively) than CIMAR (3.12) (p ≤ 0.035). CONCLUSION Eighty kiloelectron volts on VMIMAR, providing satisfactorily reduced metal artifacts and improved vascular visualization, can be an optimal recommended parameter of spectrum CT for the assessment of periprosthetic vasculature in THA patients. CRITICAL RELEVANCE STATEMENT The metal artifact is gradually reducing with increasing energy level; however, the vascular visualization is worsening. The vascular visualization is terrible above 100 keV, while the vessel is disturbed by artifacts below 70 keV. The best performance is found at 80 keV. KEY POINTS • VMIMAR can provide both reduced metal artifacts and improved vascular visualization. • Eighty kiloelectron volts on VMIMAR performs best in vascular visualization of total hip arthroplasty patients. • Energy spectrum CT is recommended for routine use in patients with total hip arthroplasty.
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Affiliation(s)
- Jie Zhao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiang Cheng
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuan Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiqi Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuchan Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Ziyi Tang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yuxi Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Haitao Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Schwarz GM, Huber S, Wassipaul C, Kasparek M, Hirtler L, Hofstätter JG, Bader T, Ringl H. Influence of Scan Parameters of Single and Dual-Energy CT Protocols in Combination with Metal Artifact Suppression Algorithms for THA: An ex Vivo Study. J Bone Joint Surg Am 2023; 105:620-629. [PMID: 36848437 DOI: 10.2106/jbjs.22.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Metal artifacts caused by hip arthroplasty stems limit the diagnostic value of computed tomography (CT) in the evaluation of periprosthetic fractures or implant loosening. The aim of this ex vivo study was to evaluate the influence of different scan parameters and metal artifact algorithms on image quality in the presence of hip stems. METHODS Nine femoral stems, 6 uncemented and 3 cemented, that had been implanted in subjects during their lifetimes were exarticulated and investigated after death and anatomical body donation. Twelve CT protocols consisting of single-energy (SE) and single-source consecutive dual-energy (DE) scans with and without an iterative metal artifact reduction algorithm (iMAR; Siemens Healthineers) and/or monoenergetic reconstructions were compared. Streak and blooming artifacts as well as subjective image quality were evaluated for each protocol. RESULTS Metal artifact reduction with iMAR significantly reduced the streak artifacts in all investigated protocols (p = 0.001 to 0.01). The best subjective image quality was observed for the SE protocol with a tin filter and iMAR. The least streak artifacts were observed for monoenergetic reconstructions of 110, 160, and 190 keV with iMAR (standard deviation of the Hounsfield units: 151.1, 143.7, 144.4) as well as the SE protocol with a tin filter and iMAR (163.5). The smallest virtual growth was seen for the SE with a tin filter and without iMAR (4.40 mm) and the monoenergetic reconstruction of 190 keV without iMAR (4.67 mm). CONCLUSIONS This study strongly suggests that metal artifact reduction algorithms (e.g., iMAR) should be used in clinical practice for imaging of the bone-implant interface of prostheses with either an uncemented or cemented femoral stem. Among the iMAR protocols, the SE protocol with 140 kV and a tin filter produced the best subjective image quality. Furthermore, this protocol and DE monoenergetic reconstructions of 160 and 190 keV with iMAR achieved the lowest levels of streak and blooming artifacts. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gilbert M Schwarz
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria.,Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.,Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
| | - Stephanie Huber
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.,Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna, Vienna, Austria
| | - Christian Wassipaul
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Jochen G Hofstätter
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.,2nd Department, Orthopedic Hospital Vienna, Vienna, Austria
| | - Till Bader
- Department of Radiology, Orthopedic Hospital Vienna, Vienna, Austria
| | - Helmut Ringl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Clinics Donaustadt, Vienna, Austria
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Advances in Bone Joint Imaging-Metal Artifact Reduction. Diagnostics (Basel) 2022; 12:diagnostics12123079. [PMID: 36553086 PMCID: PMC9776622 DOI: 10.3390/diagnostics12123079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Numerous types of metal implants have been introduced in orthopedic surgery and are used in everyday practice. To precisely evaluate the postoperative condition of arthroplasty or trauma surgery, periprosthetic infection, and the loosening of implants, it is important to reduce artifacts induced by metal implants. In this review, we focused on technical advances in metal artifact reduction using digital tomosynthesis, computed tomography, and magnetic resonance imaging. We discussed new developments in diagnostic imaging methods and the continuous introduction of novel technologies to reduce metal artifacts; however, these innovations have not yet completely removed metal artifacts. Different algorithms need to be selected depending on the size, shape, material and implanted body parts of an implant. Future advances in metal artifact reduction algorithms and techniques and the development of new sequences may enable further reductions in metal artifacts even on original images taken previously. Moreover, the combination of different imaging modalities may contribute to further reductions in metal artifacts. Clinicians must constantly update their knowledge and work closely with radiologists to select the best diagnostic imaging method for each metal implant.
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5
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Selles M, Stuivenberg VH, Wellenberg RHH, van de Riet L, Nijholt IM, van Osch JAC, van Hamersvelt RW, Leiner T, Boomsma MF. Quantitative analysis of metal artifact reduction in total hip arthroplasty using virtual monochromatic imaging and orthopedic metal artifact reduction, a phantom study. Insights Imaging 2021; 12:171. [PMID: 34817722 PMCID: PMC8613319 DOI: 10.1186/s13244-021-01111-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To quantify metal artifact reduction using 130 keV virtual monochromatic imaging (VMI) with and without orthopedic metal artifact reduction (O-MAR) in total hip arthroplasty. Methods Conventional polychromatic images and 130 keV VMI of a phantom with pellets representing bone with unilateral or bilateral prostheses were reconstructed with and without O-MAR on a dual-layer CT. Pellets were categorized as unaffected, mildly affected and severely affected. Results When 130 keV VMI with O-MAR was compared to conventional imaging with O-MAR, a relative metal artifact reduction in CT values, contrast-to-noise (CNR), signal-to-noise (SNR) and noise in mildly affected pellets (67%, 74%, 48%, 68%, respectively; p < 0.05) was observed but no significant relative metal artifact reduction in severely affected pellets. Comparison between 130 keV VMI without O-MAR and conventional imaging with O-MAR showed relative metal artifact reduction in CT values, CNR, SNR and noise in mildly affected pellets (92%, 72%, 38%, 51%, respectively; p < 0.05) but negative relative metal artifact reduction in CT values and noise in severely affected pellets (− 331% and -223%, respectively; p < 0.05), indicating aggravation of metal artifacts. Conclusion Overall, VMI of 130 keV with O-MAR provided the strongest metal artifact reduction. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01111-5.
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Affiliation(s)
- Mark Selles
- Department of Radiology, Isala, 8025 AB, Zwolle, The Netherlands.
| | | | - Ruud H H Wellenberg
- Department of Radiology, Amsterdam University Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - Loes van de Riet
- Department of Radiology, Isala, 8025 AB, Zwolle, The Netherlands.,Department of Radiology, University Medical Centre Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Ingrid M Nijholt
- Department of Radiology, Isala, 8025 AB, Zwolle, The Netherlands
| | | | | | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, 3584 CX, Utrecht, The Netherlands
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6
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Subhas N, Jun BJ, Mehta PN, Ricchetti ET, Obuchowski NA, Primak AN, Iannotti JP. Low-dose CT with metal artifact reduction in arthroplasty imaging: a cadaveric and clinical study. Skeletal Radiol 2021; 50:955-965. [PMID: 33037447 DOI: 10.1007/s00256-020-03643-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether a simulated low-dose metal artifact reduction (MAR) CT technique is comparable with a clinical dose MAR technique for shoulder arthroplasty evaluation. MATERIALS AND METHODS Two shoulder arthroplasties in cadavers and 25 shoulder arthroplasties in patients were scanned using a clinical dose (140 kVp, 300 qrmAs); cadavers were also scanned at half dose (140 kVp, 150 qrmAs). Images were reconstructed using a MAR CT algorithm at full dose and a noise-insertion algorithm simulating 50% dose reduction. For the actual and simulated half-dose cadaver scans, differences in SD for regions of interest were assessed, and streak artifact near the arthroplasty was graded by 3 blinded readers. Simulated half-dose scans were compared with full-dose scans in patients by measuring differences in implant position and by comparing readers' grades of periprosthetic osteolysis and muscle atrophy. RESULTS The mean difference in SD between actual and simulated half-dose methods was 2.42 HU (95% CI [1.4, 3.4]). No differences in streak artifact grades were seen in 13/18 (72.2%) comparisons in cadavers. In patients, differences in implant position measurements were within 1° or 1 mm in 149/150 (99.3%) measurements. The inter-reader agreement rates were nearly identical when readers were using full-dose (77.3% [232/300] for osteolysis and 76.9% [173/225] for muscle atrophy) and simulated half-dose (76.7% [920/1200] for osteolysis and 74.0% [666/900] for muscle atrophy) scans. CONCLUSION A simulated half-dose MAR CT technique is comparable both quantitatively and qualitatively with a standard-dose technique for shoulder arthroplasty evaluation, demonstrating that this technique could be used to reduce dose in arthroplasty imaging.
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Affiliation(s)
- Naveen Subhas
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Bong J Jun
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Parthiv N Mehta
- Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Nancy A Obuchowski
- Department of Biostatistics, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Andrew N Primak
- Siemens Medical Solutions USA, Inc., Malvern, PA, 19355, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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7
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Kikuchi N, Yanagawa M, Enchi Y, Nakayama A, Yoshida Y, Miyata T, Hata A, Tsubamoto M, Honda O, Tomiyama N. The effect of the reconstruction algorithm for the pulmonary nodule detection under the metal artifact caused by a pacemaker. Medicine (Baltimore) 2020; 99:e20579. [PMID: 32541487 PMCID: PMC7302625 DOI: 10.1097/md.0000000000020579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The aim was to compare the effects of metal artifacts from a pacemaker on pulmonary nodule detection among computed tomography (CT) images reconstructed using filtered back projection (FBP), single-energy metal artifact reduction (SEMAR), and forward-projected model-based iterative reconstruction solution (FIRST).Nine simulated nodules were placed inside a chest phantom with a pacemaker. CT images reconstructed using FBP, SEMAR, and FIRST were acquired at low and standard dose, and were evaluated by 2 independent radiologists.FIRST demonstrated the most significantly improved metal artifact and nodule detection on low dose CT (P < .0032), except at 10 mA and 5-mm thickness. At standard-dose CT, SEMAR showed the most significant metal artifact reduction (P < .00001). In terms of nodule detection, no significant differences were observed between FIRST and SEMAR (P = .161).With a pacemaker present, FIRST showed the best nodule detection ability at low-dose CT and SEMAR is comparable to FIRST at standard dose CT.
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Affiliation(s)
- Noriko Kikuchi
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
| | - Masahiro Yanagawa
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
| | - Yukihiro Enchi
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, Suita
| | - Akiko Nakayama
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
| | - Yuriko Yoshida
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
| | - Tomo Miyata
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
| | - Akinori Hata
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
| | - Mitsuko Tsubamoto
- From the Department of Radiology, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Osamu Honda
- From the Department of Radiology, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Noriyuki Tomiyama
- From the Department of Radiology, Osaka University Graduate School of Medicine, Suita-city
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Development of a denoising convolutional neural network-based algorithm for metal artifact reduction in digital tomosynthesis for arthroplasty: A phantom study. PLoS One 2019; 14:e0222406. [PMID: 31518374 PMCID: PMC6743787 DOI: 10.1371/journal.pone.0222406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to develop a denoising convolutional neural network metal artifact reduction hybrid reconstruction (DnCNN-MARHR) algorithm for decreasing metal objects in digital tomosynthesis (DT) for arthroplasty by using projection data. For metal artifact reduction (MAR), we implemented a DnCNN-MARHR algorithm based on a training network (mini-batch stochastic gradient descent algorithm with momentum) to estimate the residual reference (140 keV virtual monochromatic [VM]) and object (70 kV with metal artifacts) images. For this, we used projection data and subtracted the estimated residual images from the object images, involving hybrid and subjectively reconstructed image usage (back projection and maximum likelihood expectation maximization [MLEM]). The DnCNN-MARHR algorithm was compared with the dual-energy material decomposition reconstruction algorithm (DEMDRA), VM, MLEM, established and commonly used filtered back projection (FBP), and a simultaneous algebraic reconstruction technique-total variation (SART-TV) with MAR processing. MAR was compared using artifact index (AI) and texture analysis. Artifact spread functions (ASFs) for images that were out-of-plane and in-focus were evaluated using a prosthesis phantom. The overall performance of the DnCNN-MARHR algorithm was adequate with regard to the ASF, and the derived images showed better results, without being influenced by the metal type (AI was almost equal to the best value for the DEMDRA). In the ASF analysis, the DnCNN-MARHR algorithm generated better MAR compared with that obtained employing usual algorithms for reconstruction using MAR processing. In addition, comparison of the difference (mean square error) between DnCNN-MARHR and the conventional algorithm resulted in the smallest VM. The DnCNN-MARHR algorithm showed the best performance with regard to image homogeneity in the texture analysis. The proposed algorithm is particularly useful for reducing artifacts in the longitudinal direction, and it is not affected by tissue misclassification.
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Chou R, Li JH, Ying LK, Lin CH, Leung W. Quantitative assessment of three vendor's metal artifact reduction techniques for CT imaging using a customized phantom. Comput Assist Surg (Abingdon) 2019; 24:34-42. [PMID: 31502481 DOI: 10.1080/24699322.2019.1649075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A metal implant was placed in an acrylic phantom to enable quantitative analysis of the metal artifact reduction techniques used in computed tomography (CT) scanners from three manufacturers. Two titanium rods were placed in a groove in a cylindrical phantom made by acrylic, after which the groove was filled with water. The phantom was scanned using three CT scanners (Toshiba, GE, Siemens) under the abdomen CT setting. CT number accuracy, contrast-to-noise ratio, area of the metal rods in the images, and fraction of affected pixel area of water were measured using ImageJ. Different iterative reconstruction, dual energy, and metal artifact reduction techniques were compared within three vendors. The highest contrast-to-noise ratio of three scanners were 85.7 ± 8.4 (Toshiba), 85.9 ± 11.7 (GE), and 55.0 ± 14.8 (Siemens); and the most correct results of metal area were 157.1 ± 1.4 mm2 (Toshiba), 155.0 ± 1.0 (GE), and 170.6 ± 5.3 (Siemens). The fraction of affected pixel area obtained using single-energy metal artifact reduction of Toshiba scanner was 2.2% ± 0.7%, which is more favorable than 4.1% ± 0.7% obtained using metal artifact reduction software of GE scanner (p = 0.002). Among all quantitative results, the estimations with fraction of affected pixel areas matched the effect of metal artifact reduction in the actual images. Therefore, the single-energy metal artifact reduction technique of Toshiba scanner had a desirable effect. The metal artifact reduction software of GE scanner effectively reduced the effect of metal artifacts; however, it underestimated the size of the metal rods. The monoenergetic and dual energy composition techniques of Siemens scanner could not effectively reduce metal artifacts.
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Affiliation(s)
- Ryan Chou
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology , Taichung , Taiwan.,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management , Kaohsiung , Taiwan
| | - Jung-Hui Li
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Liu-Kuo Ying
- Department of Radiology, E-DA Cancer Hospital , Kaohsiung , Taiwan
| | - Cheng-Hsun Lin
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology , Taichung , Taiwan
| | - Wan Leung
- Department of Radiation Oncology, Yuan's General Hospital , Kaohsiung , Taiwan
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10
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Wellenberg RHH, van Osch JAC, Boelhouwers HJ, Edens MA, Streekstra GJ, Ettema HB, Boomsma MF. CT radiation dose reduction in patients with total hip arthroplasties using model-based iterative reconstruction and orthopaedic metal artefact reduction. Skeletal Radiol 2019; 48:1775-1785. [PMID: 31016340 PMCID: PMC6776565 DOI: 10.1007/s00256-019-03206-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/08/2019] [Accepted: 03/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the impact of radiation dose reduction on image quality in patients with metal-on-metal total hip arthroplasties (THAs) using model-based iterative reconstruction (MBIR) combined with orthopaedic metal artefact reduction (O-MAR). MATERIALS AND METHODS Patients with metal-on-metal THAs received a pelvic CT with a full (FD) and a reduced radiation dose (RD) with -20%, -40%, -57%, or -80% CT radiation dose respectively, when assigned to group 1, 2, 3, or 4 respectively. FD acquisitions were reconstructed with iterative reconstruction, iDose4. RD acquisitions were additionally reconstructed with iterative model-based reconstruction (IMR) levels 1-3 with different levels of noise suppression. CT numbers, noise and contrast-to-noise ratios were measured in muscle, fat and bladder. Subjective image quality was evaluated on seven aspects including artefacts, osseous structures, prosthetic components and soft tissues. RESULTS Seventy-six patients were randomly assigned to one of the four groups. While reducing radiation dose by 20%, 40%, 57%, or 80% in combination with IMR, CT numbers remained constant. Compared with iDose4, the noise decreased (p < 0.001) and contrast-to-noise ratios increased (p < 0.001) with IMR. O-MAR improved CT number accuracy in the bladder and reduced noise in the bladder, muscle and fat (p < 0.01). Subjective image quality was rated lower on RD IMR images than FD iDose4 images on all seven aspects (p < 0.05) and was not related to the applied radiation dose reduction. CONCLUSION In RD IMR with O-MAR images, CT numbers remained constant, noise decreased and contrast-to-noise ratios between muscle and fat increased compared with FD iDose4 with O-MAR images in patients with metal-on-metal THAs. Subjective image quality reduced, regardless of the degree of radiation dose reduction.
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Affiliation(s)
- Ruud H. H. Wellenberg
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands ,grid.7177.60000000084992262Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jochen A. C. van Osch
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Henk J. Boelhouwers
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | - Mireille A. Edens
- grid.452600.50000 0001 0547 5927Department of Innovation and Science, Isala, Zwolle, The Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Harmen B. Ettema
- grid.452600.50000 0001 0547 5927Department of Orthopedic Surgery, Isala, Zwolle, The Netherlands
| | - Martijn F. Boomsma
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
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11
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Reducing artifacts from total hip replacements in dual layer detector CT: Combination of virtual monoenergetic images and orthopedic metal artifact reduction. Eur J Radiol 2018; 111:14-20. [PMID: 30691660 DOI: 10.1016/j.ejrad.2018.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the reduction of artifacts caused by total hip replacements (THR) in dual-layer DECT (DLCT) provided by the combination of virtual monoenergetic images (VMI) and orthopedic metal artifact reduction (MAR). MATERIALS AND METHODS A total of 24 consecutive patients carrying THR, who received DLCT, were included. Four different images were reconstructed from the same CT dataset: a) conventional images (CI), b) conventional images with orthopedic metal artifact reduction (CIMAR) c) VMI and d) VMI combined with orthopedic metal artifact reduction (VMIMAR). VMI and VMIMAR were reconstructed at 140 keV, 160 keV, 180 keV and 200 keV. Attenuation (HU) and noise (SD) were measured in order to evaluate reduction of hypodense and hyperdense artifacts, evaluate reduction of image noise as well as to calculate contrast-to-noise ratios (CNR). Image quality was additionally rated with regard to: a) extent of artifact reduction and assessment of b) pelvic organs, c) bone and d) muscle adjacent to the metal implants. Statistical analysis was performed using Wilcoxon test. RESULTS VMIMAR at high keV, 140, 160, 180 and 200 keV, led to the greatest reduction of hypodense artifacts in comparison to plain VMI or CIMAR (p < 0.01), while in comparison to CI hyperdense artifacts were significantly reduced in all reconstructions (p < 0.05). Accordingly, subjective analysis found VMIMAR to be superior in reducing hypodense artifacts in comparison to VMI and CIMAR (p < 0.05), while hyperdense artifacts were equally reduced in all reconstructions compared to CI (p < 0.0001). Additionally, assessment of the pelvic organs and adjacent bone was significantly improved in VMIMAR in comparison to VMI and CIMAR (p < 0.05). In contrast, muscles adjacent to the metal implants were significantly better assessable in all reconstructions compared to CI (p < 0.01). CONCLUSION The combination of VMI and MAR yields strongest reduction of hypo- and hyperdense artifacts caused by total hip replacements in staging DLCT in comparison to each technique by itself.
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Development of a novel algorithm for metal artifact reduction in digital tomosynthesis using projection-based dual-energy material decomposition for arthroplasty: A phantom study. Phys Med 2018; 53:4-16. [DOI: 10.1016/j.ejmp.2018.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/13/2018] [Accepted: 07/28/2018] [Indexed: 11/22/2022] Open
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Wellenberg RHH, Hakvoort ET, Slump CH, Boomsma MF, Maas M, Streekstra GJ. Metal artifact reduction techniques in musculoskeletal CT-imaging. Eur J Radiol 2018; 107:60-69. [PMID: 30292274 DOI: 10.1016/j.ejrad.2018.08.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/02/2018] [Accepted: 08/11/2018] [Indexed: 01/02/2023]
Abstract
It is known that metal artifacts can be reduced by modifying standard acquisition and reconstruction, by modifying projection data and/or image data and by using virtual monochromatic imaging extracted from dual-energy CT. In this review we focus on the origin of metal artifacts, technical background of commercially available metal artifact reduction (MAR) algorithms and the value of dual-energy CT and MAR software for different metal hardware in current clinical practice. Virtual monochromatic imaging reduces beam-hardening artifacts, where metal artifact reduction software effectively reduces artifacts caused by extensive photon-starvation. Both techniques have their advantages and disadvantages, and the combination of both techniques is often but not always the best solution regarding metal artifact reduction. Advances in prosthetic imaging are reinforced by advances in prosthetic design. Providing implant specific information prior to scanning is important in order to adjust the metal artifact reduction approach, minimize artifacts and optimize image quality and diagnostic value of CT.
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Affiliation(s)
- R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Radiology, Isala, Zwolle, The Netherlands.
| | - E T Hakvoort
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
| | - C H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - M F Boomsma
- Department of Radiology, Isala, Zwolle, The Netherlands.
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
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Long Z, Bruesewitz MR, DeLone DR, Morris JM, Amrami KK, Adkins MC, Glazebrook KN, Kofler JM, Leng S, McCollough CH, Fletcher JG, Halaweish AF, Yu L. Evaluation of projection- and dual-energy-based methods for metal artifact reduction in CT using a phantom study. J Appl Clin Med Phys 2018; 19:252-260. [PMID: 29749048 PMCID: PMC6036383 DOI: 10.1002/acm2.12347] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/11/2018] [Accepted: 03/27/2018] [Indexed: 12/30/2022] Open
Abstract
Objectives Both projection and dual‐energy (DE)‐based methods have been used for metal artifact reduction (MAR) in CT. The two methods can also be combined. The purpose of this work was to evaluate these three MAR methods using phantom experiments for five types of metal implants. Materials and Methods Five phantoms representing spine, dental, hip, shoulder, and knee were constructed with metal implants. These phantoms were scanned using both single‐energy (SE) and DE protocols with matched radiation output. The SE data were processed using a projection‐based MAR (iMAR, Siemens) algorithm, while the DE data were processed to generate virtual monochromatic images at high keV (Mono+, Siemens). In addition, the DE images after iMAR were used to generate Mono+ images (DE iMAR Mono+). Artifacts were quantitatively evaluated using CT numbers at different regions of interest. Iodine contrast‐to‐noise ratio (CNR) was evaluated in the spine phantom. Three musculoskeletal radiologists and two neuro‐radiologists independently ranked the artifact reduction. Results The DE Mono+ at high keV resulted in reduced artifacts but also lower iodine CNR. The iMAR method alone caused missing tissue artifacts in dental phantom. DE iMAR Mono+ caused wrong CT numbers in close proximity to the metal prostheses in knee and hip phantoms. All musculoskeletal radiologists ranked SE iMAR > DE iMAR Mono+ > DE Mono+ for knee and hip, while DE iMAR Mono+ > SE iMAR > DE Mono+ for shoulder. Both neuro‐radiologists ranked DE iMAR Mono+ > DE Mono+ > SE iMAR for spine and DE Mono+ > DE iMAR Mono+ > SE iMAR for dental. Conclusions The SE iMAR was the best choice for the hip and knee prostheses, while DE Mono+ at high keV was best for dental implants and DE iMAR Mono+ was best for spine and shoulder prostheses. Artifacts were also introduced by MAR algorithms.
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Affiliation(s)
- Zaiyang Long
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mark C Adkins
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - James M Kofler
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Dose Reduction With Dedicated CT Metal Artifact Reduction Algorithm: CT Phantom Study. AJR Am J Roentgenol 2017; 210:593-600. [PMID: 29231758 DOI: 10.2214/ajr.17.18544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to compare reader accuracy detecting lesions near hardware in a CT phantom model at different radiation exposures using an advanced metal artifact reduction (MAR) algorithm and standard filtered back projection (FBP) techniques and to determine if radiation exposure could be decreased using MAR without compromising lesion detectability. MATERIALS AND METHODS A CT phantom manufactured with spherical lesions of various sizes (10-20 mm) and attenuations (20-50 HU) embedded around cobalt-chromium spheres attached to titanium rods, simulating an arthroplasty, was scanned on a single CT scanner (FLASH, Siemens Healthcare) at 140 kVp and 0.6-mm collimation using clinical-dose (300 Quality Reference mAs [Siemens Healthcare]), low-dose (150 Quality Reference mAs), and high-dose (600 Quality Reference mAs) protocols. Images reconstructed with iterative MAR, advanced modeled iterative reconstruction (ADMIRE), and FBP with identical parameters were anonymized and independently reviewed by three radiologists. Accuracies for detecting lesions, measured as AUC, sensitivity, and specificity, were compared. RESULTS Accuracy using MAR was significantly higher than that using FBP at all exposures (p values ranged from < 0.001 to 0.021). Sensitivity was also higher for MAR than for FBP at all exposures. Specificity was very high for both reconstruction techniques at all exposures with no significant differences. Accuracy of low-dose MAR was higher than and not inferior to standard-dose and high-dose FBP. MAR was significantly more sensitive than FBP in detecting smaller lesions (p = 0.021) and lesions near high streak artifact (p < 0.001). CONCLUSION MAR improves reader accuracy to detect lesions near hardware and allows significant reductions in radiation exposure without compromising accuracy compared with FBP in a CT phantom model.
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Gomi T, Sakai R, Goto M, Hara H, Watanabe Y, Umeda T. Evaluation of digital tomosynthesis reconstruction algorithms used to reduce metal artifacts for arthroplasty: A phantom study. Phys Med 2017; 42:28-38. [PMID: 29173918 DOI: 10.1016/j.ejmp.2017.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/13/2017] [Accepted: 07/30/2017] [Indexed: 11/15/2022] Open
Abstract
To investigate methods to reduce metal artifacts during digital tomosynthesis for arthroplasty, we evaluated five algorithms with and without metal artifact reduction (MAR)-processing tested under different radiation doses (0.54, 0.47, and 0.33mSv): adaptive steepest descent projection onto convex sets (ASD-POCS), simultaneous algebraic reconstruction technique total variation (SART-TV), filtered back projection (FBP), maximum likelihood expectation maximization (MLEM), and SART. The algorithms were assessed by determining the artifact index (AI) and artifact spread function (ASF) on a prosthesis phantom. The AI data were statistically analyzed by two-way analysis of variance. Without MAR-processing, the greatest degree of effectiveness of the MLEM algorithm for reducing prosthetic phantom-related metal artifacts was achieved by quantification using the AI (MLEM vs. ASD-POCS, SART-TV, SART, and FBP; all P<0.05). With MAR-processing, the greatest degree of effectiveness of the MLEM, ASD-POCS, SART-TV, and SART algorithms for reducing prosthetic phantom-related metal artifacts was achieved by quantification using the AI (MLEM, ASD-POCS, SART-TV, and SART vs. FBP; all P<0.05). When assessed by ASF, metal artifact reduction was largest for the MLEM algorithm without MAR-processing and ASD-POCS, SART-TV, and SART algorithm with MAR-processing. In ASF, the effect of metal artifact reduction was always greater at reduced radiation doses, regardless of which reconstruction algorithm with and without MAR-processing was used. In this phantom study, the MLEM algorithm without MAR-processing and ASD-POCS, SART-TV, and SART algorithm with MAR-processing gave improved metal artifact reduction.
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Affiliation(s)
- Tsutomu Gomi
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan.
| | - Rina Sakai
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Masami Goto
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Hidetake Hara
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Yusuke Watanabe
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Tokuo Umeda
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
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