[Suggestion of the Relative Artifact Index for Noise-independent Evaluation of the Streak Artifact]

Usefulness of high tube voltage conditions in CT Fluoroscopy during CT-guided biopsy: Preliminary study

Objectives

Computed tomography (CT)-guided biopsy is often used to increase the safety and accuracy of biopsies for disease diagnosis. However, CT-guided biopsy is associated with metal artifacts from the biopsy needle and increased patient and operator exposure due to frequent CT fluoroscopy. Therefore, we thought it possible to solve this problem by setting the CT fluoroscopy conditions to a higher tube voltage and a lower tube current-time product (high-tube voltage conditions) than recommended. As a preliminary study, metal artifacts, low-contrast detectability, patient and operator's exposure, and visual changes in high-tube voltage conditions were assessed using phantoms and compared with recommended conditions.

Material and Methods

On an interventional radiology CT system, the phantom was scanned under recommended conditions (120 kV, 30 mAs) and high-tube voltage conditions (135 kV, 30-5 mAs). The metal artifacts and low-contrast detectability of each condition were analyzed and compared using the acquired images. In addition, the phantom surface dose assuming patient exposure and the air dose assuming the operator's standing position were measured and compared. Furthermore, visual assessment was performed by six radiological technologists.

Results

Low-contrast detectability was slightly reduced, metal artifacts were significantly lower under high-tube voltage conditions, and patient and operator exposure were lower than the recommended conditions. Furthermore, the findings of the visual assessment were largely consistent with those of the physical assessment.

Conclusion

High-tube voltage conditions in CT fluoroscopy during CT-guided biopsy may be useful in reducing metallic artifacts and patient and operator radiation exposure.

Noise-related inaccuracies in the quantitative evaluation of CT artifacts

Accuracies of measuring the artifact index (AI), a quantitative artifact evaluation index in X-ray CT images, were investigated. The AI is calculated based not only on the standard deviation (SD) of the artifact area in the image, but also on the SD of noise components for considering the noise influence. However, conventional measurement methods may not follow this consideration, for example the non-uniformity of the noise distribution is not taken into account, resulting in reducing the accuracy of AI. To address this problem, this study aims to clarify the impact of noise SD measuring (NSDM) error on AI accuracy and improve the accuracy by reducing the NSDM error. Experimental results demonstrated that the conventional noise measurement methods reduced the accuracy of the AI. Specifically, AI inaccuracy due to the NSDM error is severe in the case of weak artifacts and under high noise conditions. Furthermore, the AI accuracy can be improved by reducing the influence of the NSDM error through image smoothing or by correcting NSDM through noise distribution estimation. These results showed that AI can be affected by NSDM errors practically even though it is robust against noise in principle. The impact of NSDM errors must be avoided for reliable artifact evaluation.

Artifact reduction in low and ultra-low dose chest computed tomography for patients with pacemaker: A phantom study

INTRODUCTION

Implanted pacemakers (PM) would decrease the detection of lung nodules in chest computed tomography (CT) due to the metal artifact. This study aimed to explore the computer-aided diagnosis (CAD) detectability of pulmonary nodules for the patients implanted with PMs in low- and ultra-low-dose chest CT screening.

METHODS

Four different sizes of artificial nodules were placed in an anthropomorphic chest phantom with two alternative diameters utilized. A commercially available PM was placed on the surface of the left chest wall of the phantom. The image acquisitions were performed with 120 kV and 150 kV with a dedicated selective photon shield made of tin filter (Sn150 kV) at low- and ultra-low- radiation doses (1.0 and 0.5 mGy of volume CT dose index), and reconstructed with and without Iterative Metal Artifact Reduction (iMAR, Siemens Healthineers, Erlangen, Germany). The relative artifact index (AIr) was calculated as an index of metal artifacts, and the nodule detectability was evaluated with a CAD system.

RESULTS

Sn150 kV reduced AIr in all acquisitions when comparing 120 kV and Sn150 kV. Although PM reduced the detectability of nodules, Sn150 kV showed higher detectability compared to 120 kV. The use of iMAR showed inconsistent results in nodule detectability.

CONCLUSION

Sn150 kV reduced PM-induced metal artifacts and improved nodule detectability with CAD compared to 120 kV acquisition in many conditions including low and ultra-low doses and large phantoms, but iMAR did not improve the detectability.

IMPLICATIONS FOR PRACTICE

Based on the results of the current phantom study, low and ultra-low dose with Sn150 kV acquisition reduced PM-induced metal artifacts and improved nodule detectability.

Gumbel distribution-based technique enables quantitative comparison between streak metal artifacts of multidetector row CT and cone-beam CT: a phantom study

Cone-beam computed tomography (CBCT), derived from multidetector row CT (MDCT), has a high spatial resolution and has recently been applied to various organs. One of the severe limitations common to CBCT and MDCT is metal artifacts. In particular, streak metal artifacts (SMAs) between multiple metal materials often hinder diagnosis. However, no studies have quantitatively compared the strength of SMAs in MDCT and CBCT. Nomura et al. reported an evaluation method specialized in SMAs of CBCT using the Gumbel distribution (GD), which can also be applied to SMAs of MDCT (Oral Surg Oral Med Oral Pathol Oral Radiol 131: 494-502, 2021, https://doi.org/10.1016/J.OOOO.2020.08.031 ). This study aimed to quantitatively compare SMAs occurring between titanium materials on MDCT and CBCT images using the GD-based method. The SMAs were investigated as follows: A hydroxyapatite block was sandwiched between two titanium rods to generate an SMA. They were placed in an acrylic phantom, simulating a human head, and scanned using an MDCT scanner and two CBCT scanners. The obtained images were analyzed using Gumbel plots and location parameters, and the SMA strength was calculated. The results showed that the SMAs on the MDCT images were significantly weaker than those on the CBCT images. In the CBCT scans, a smaller volume CT dose index value caused stronger SMAs. These results indicate that MDCT is more advantageous than CBCT in terms of SMA reduction when bone morphology between titanium materials must be evaluated. The characteristic should be considered in clinical cases.

Influence of field of view size and reconstruction methods on single-energy metal artifact reduction: a phantom study

The purpose of this study was to evaluate the effect of single-energy metal artifact reduction (SEMAR) for metal artifacts using CT images reconstructed with adaptive iterative dose reduction three dimensional (AIDR3D) and advanced intelligent clear-IQ engine (AiCE) in calibration-field of view of various sizes. A prosthetic hip joint was arranged at the center of the phantom. The phantom images were scanned by changing calibration-field of view of 320 mm and 500 mm, and were reconstructed using filtered back-projection (FBP), AIDR3D, and AiCE with and without SEMAR, respectively. The metal artifact reduction with SEMAR was evaluated by calculated the relative artifact index value and visual scores in degree of artifact by seven radiology technologists. Relative artifact index of FBP, AIDR3D, and AiCE with 320 mm/500 mm calibration-field of views were 10.2/10.0, 16.3/16.4, and 17.8/17.9 without SEMAR, 3.3/3.1, 2.6/2.5, and 2.3/2.0 with SEMAR, respectively. Visual scores were not significantly different between 320 and 500 mm calibration-field of views in all reconstruction methods. The effect of metal artifact reduction was not affected by calibration-field of view sizes in the SEMAR combined with AIDR3D or AiCE.

Evaluation of streak metal artifacts in cone beam computed tomography by using the Gumbel distribution: a phantom study

OBJECTIVE

The aim of this study was to confirm whether streak metal artifacts (SMAs) between titanium implants on cone beam computed tomography (CBCT) images could be evaluated by using the Gumbel distribution (GD). Moreover, the influence of different scan settings on SMAs was investigated.

STUDY DESIGN

An iodine solution simulating dentin was placed between 2 titanium rods in an acrylic phantom. It was scanned by using CBCT at 2 settings with nearly equivalent exposure doses (90 kV, 7 mA; 78 kV, 10 mA). The images were analyzed, and the dependence of the voxel values in SMAs on GD was investigated with the coefficient of determination (r²). The location parameters, indicating the strength of the SMAs, were calculated for each scan setting and evaluated with the Mann-Whitney U test. Significance was established at p = .05.

RESULTS

The SMAs on CBCT images depended on GD (r² ≥ .959). The SMAs with the 78 kV, 10 mA settings were significantly smaller than those with the 90 kV, 7 mA settings (p < .01).

CONCLUSIONS

SMAs on CBCT images could be evaluated by using methods based on GD. The strengths of metal artifacts varied with changes in scan settings, even at nearly equivalent exposure doses.