C-arm CT Images Research Articles

Development of learning-based online C-arm CT imaging technique for image-guided adaptive brachytherapy

Existing protocols for image-guided adaptive brachytherapy (BT) pose distinct limitations, which include: (1) the possible misalignment of the application position as a consequence of patient translocation between the treatment room and the computed tomography (CT)/magnetic resonance imaging (MRI) suite, (2) an inherent inability to continually monitor physiological and anatomical changes during the course of 3–10 fraction treatment regimens, and (3) insufficient tracing of the radioactive source movement within the patient's body. In response to these challenges, this study proposes an innovative deep-learning-based C-arm CT/SPECT imaging system tailored specifically for image-guided adaptive BT. This technological advancement aims to enable the execution of high-precision online adaptive BT, thereby amplifying the adaptability and effectiveness of oncological care. An image dataset of 66 non-contrast pelvic CT studies was acquired and limited-angle cone-beam CT (CBCT) images were generated by mathematically calculating sinograms for voxel phantoms based on these CT images. Using a Generative Adversarial Network (GAN), low-quality CBCT images obtained using a 110° limited-angle rotating C-arm system were transformed into high-quality diagnostic CT images. The performances of these networks were evaluated by comparing them with CBCT images reconstructed using an iterative reconstruction method and ground-truth images. Synthetic CT images were successfully transformed from low-quality CBCT images, considerably reducing streaking artifacts and preserving the anatomical structures. Our deep-learning-based image reconstruction technique could successfully improve the image quality of limited-angle CBCT, similar to the ground-truth image quality, with a faster speed than the latest iterative reconstruction algorithm. We expect that this will be effectively implemented in online image-guided adaptive BT and patient dose verification.

Dual-energy CT imaging over non-overlapping, orthogonal arcs of limited-angular ranges.

Interest exists in dual-energy computed tomography (DECT) imaging with scanning arcs of limited-angular ranges (LARs) for reducing scan time and radiation dose, and for enabling scan configurations of C-arm CT that can avoid possible collision between the rotating X-ray tube/detector and the imaged subject. In this work, we investigate image reconstruction for a type of configurations of practical DECT interest, referred to as the two-orthogonal-arc configuration, in which low- and high-kVp data are collected over two non-overlapping arcs of equal LAR α, ranging from 30° to 90°, separated by 90°. The configuration can readily be implemented, e.g., on CT with dual sources separated by 90° or with the slow-kVp-switching technique. The directional-total-variation (DTV) algorithm developed previously for image reconstruction in conventional, single-energy CT is tailored to enable image reconstruction in DECT with two-orthogonal-arc configurations. Performing visual inspection and quantitative analysis of monochromatic images obtained and effective atomic numbers estimated, we observe that the monochromatic images of the DTV algorithm from LAR data are with substantially reduced LAR artifacts, which are observed otherwise in those of existing algorithms, and thus visually correlate reasonably well, in terms of metrics PCC and nMI, with their reference images obtained from full-angular-range data. In addition, effective atomic numbers estimated from LAR data of DECT with two-orthogonal-arc configurations are in reasonable agreement, with relative errors up to ∼ 10%, with those estimated from full-angular-range data in DECT. The results acquired in the work may yield insights into the design of LAR configurations of practical dual-energy application relevance in diagnostic CT or C-arm CT imaging.

C-arm CT imaging with the extended line-ellipse-line trajectory: first implementation on a state-of-the-art robotic angiography system

Three-dimensional cone-beam imaging has become valuable in interventional radiology. Currently, this tool, referred to as C-arm CT, employs a circular short-scan for data acquisition, which limits the axial volume coverage and yields unavoidable cone-beam artifacts. To improve flexibility in axial coverage and image quality, there is a critical need for novel data acquisition geometries and related image reconstruction algorithms. For this purpose, we previously introduced the extended line-ellipse-line trajectory, which allows complete scanning of arbitrary volume lengths in the axial direction together with adjustable axial beam collimation, from narrow to wide depending on the targeted application. A first implementation of this trajectory on a state-of-the-art robotic angiography system is reported here. More specifically, an assessment of the quality of this first implementation is presented. The assessment is in terms of geometric fidelity and repeatability, complemented with a first visual inspection of how well the implementation enables imaging an anthropomorphic head phantom. The geometric fidelity analysis shows that the ideal trajectory is closely emulated, with only minor deviations that have no impact on data completeness and clinical practicality. Also, mean backprojection errors over short-term repetitions are shown to be below the detector pixel size at field-of-view center for most views, which indicates repeatability is satisfactory for clinical utilization. These repeatability observations are further supported by values of the Structural Similarity Index Metric above 94% for reconstructions of the FORBILD head phantom from computer-simulated data based on repeated data acquisition geometries. Last, the real data experiment with the anthropomorphic head phantom shows that the high contrast features of the phantom are well reconstructed without distortions as well as without breaks or other disturbing transition zones, which was not obvious given the complexity of the data acquisition geometry and the major variations in axial coverage that occur over the scan.

Compressed Sensing based Image Reconstruction with Projection Recovery for Limited Angle Cone-Beam CT Imaging.

This paper presents a new 3D CT image reconstruction for limited angle C-arm cone-beam CT imaging system based on total-variation (TV) regularized in image domain and L1-penalty in projection domain. This is motivated by the facts that the CT images are sparse in TV setting and their projections are sinusoid-like forms, which are sparse in the discrete cosine transform (DCT) domain. Furthermore, the artifacts in image domain are directional due to limited angle views, so the anisotropic TV is employed. And the reweighted L1penalty in projection domain is adopted to enhance sparsity. Hence, this paper applied the anisotropic TV-norm and reweighted L1-norm sparse techniques to the limited angle Carm CT imaging system to enhance the image quality in both CT image and projection domains. Experimental results also show the efficiency of the proposed method.Clinical Relevance-This new CT reconstruction approach provides high quality images and projections for practicing clinicians.

Application of High-Resolution C-Arm CT Combined with Streak Metal Artifact Removal Technology for the Stent-Assisted Embolization of Intracranial Aneurysms.

Metal artifacts from coils and stents limit the level of detail in C-arm CT images of stent attachment and coiling attenuation in the aneurysm neck. We evaluated the utility of high-resolution C-arm CT combined with streak metal artifact removal technology for stent-assisted embolization of intracranial aneurysms. From October 2017 to July 2018, the First Affiliated Hospital of Zhengzhou University treated 107 patients with intracranial aneurysms (118 aneurysms in total) with stent-assisted embolization. Conventional C-arm CT and high-resolution C-arm CT scanning of the stented area were performed during and after treatment. 3D images were reconstructed with and without streak metal artifact removal techniques. Subsequently, the image quality was compared. The reconstructed images indicated the stent deployment degree and packing density. Follow-up assessments included clinical and angiographic outcomes and complications. In total, 118 aneurysms were successfully embolized using 118 stents. Image quality was significantly higher (P < .05) with high-resolution C-arm CT combined with streak metal artifact removal reconstruction. Streak metal artifact removal reconstruction and 2D angiography at working angles showed incomplete deployment of 6 stents and incomplete aneurysm embolization of 15 patients, which were subsequently resolved. One case of hemorrhage was noted postoperatively. Follow-up of 93 patients at 6-13 months indicated 3 cases of aneurysm recurrence. High-resolution C-arm CT combined with the streak metal artifact removal technique effectively reduced metal artifacts from stents and coils during aneurysm embolization. This method can help physicians determine the extent of stent deployment and the packing density of coils and thus potentially reduce complications and aneurysm recurrence.

Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT

PurposeWe used an imaging technique based on 3-dimensional (3D) C-arm CT to assess the apposition of three types of stents after coiling of intracranial aneurysms.MethodsAll patients with intracranial aneurysms were...

Preliminary clinical study of C-arm CT assisted transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension

Objective To explore the value of C-arm CT in transjugular intrahepatic portosystemic shunt (TIPS). Methods Between June 2015 and October 2017, a total of 16 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertention in our center were retrospectively enrolled in the study. Abdominal enhanced CT was routinely performed before surgery. Postprocessing images of portal vein were used as a guidance of TIPS in real time after integrated with intraoperative c-arm CT images during selective operations. Results The success rate of C-arm CT-guided TIPS was 100%. Portal vein angiography showed the position basically consistent with CT matched images reference position. No obvious abdominal hemorrhage, injury of biliary tract and other complications occurred in all patients. The mean number of needle passes was 2.1±0.9 passes(range of 1.0-4.0 passes), the mean time of portal vein entry was 4.3±1.9 min (range of 2.0-8.0 min), the mean fluoroscopy period was 22.6±4.8 min (range of 17.0-32.0 min), DAP was (256.2±96.7)mGy/cm2. Conclusion C-arm CT-guided TIPS is technically feasible and safe. Key words: Hypertension, portal; Radiology, interventional; Portasystemic shunt, transjugular tntrahepatic; Tomography, X-Ray Computed; C-arm CT

Interventional dual-energy imaging-Feasibility of rapid kV-switching on a C-arm CT system.

In the last years, dual-energy CT imaging has shown clinical value, thanks to its ability to differentiate materials based on their atomic number and to exploit different properties of images acquired at two different energies. C-arm CT systems are used to guide procedures in the interventional suite. Until now, there are no commercially available systems that employ dual-energy material decomposition. This paper explores the feasibility of implementing a fast kV-switching technique on a clinically available angiographic system for acquiring dual-energy C-arm CT images. As an initial proof of concept, a fast kV-switching approach was implemented on an angiographic C-arm system and the peak tube voltage during 3D rotational scans was measured. The tube voltage measurements during fast kV-switching scans were compared to corresponding measurements on kV-constant scans. Additionally, to prove stability of the requested exposure parameters, the accuracy of the delivered tube current and pulse width were also recorded and compared. In a first phantom experiment, the voxel intensity values of the individual tube voltage components of the fast kV-switching scans were compared to their corresponding kV-constant scans. The same phantom was used for a simple material decomposition between different iodine concentrations and pure water using a fast kV-switching protocol of 81 and 125 kV. In the last experiment, the same kV-switching protocol as in the phantom scan was used in an in vivo pig study to demonstrate the clinical feasibility. During rapid kV-switching acquisitions, the measured tube voltage of the x-ray tube during fast switching scans has an absolute deviation of 0.23 ± 0.13 kV compared to the measured tube voltage produced during kV-constant acquisitions. The stability of the peak tube voltage over different scan requests was about 0.10 kV for the low and 0.46 for the high energy kV-switching scans and less than 0.1 kV for kV-constant scans, indicating slightly lower stability for kV-switching scans. The tube current resulted in a relative deviation of -1.6% for the low and 6.6% overestimation for the high tube voltage of the kV-switching scans compared to the kV-constant scans. The pulse width showed no deviation for the longer pulse width and only minor deviations (0.02 ± 0.02 ms) for the shorter pulse widths compared to the kV-constant scans. The phantom experiment using different iodine concentrations showed an accurate correlation (R2 > 0.99) between the extracted intensity values in the kV-switching and kV-constant reconstructed volumes, and allows for an automatic differentiation between contrast concentration down to 10% (350 mg/ml iodine) and pure water under low-noise conditions. Preliminary results of iodine and soft tissue separation showed also promising results in the first in vivo pig study. The feasibility of dual-energy imaging using a fast kV-switching method on an angiographic C-arm CT system was investigated. Direct measurements of beam quality in the x-ray field demonstrate the stability of the kV-switching method. Phantom and in vivo experiments showed that images did not deviate from those of corresponding kV-constant scans. All performed experiments confirmed the capability of performing fast kV-switching scans on a clinically available C-arm CT system. More complex material decomposition tasks and postprocessing steps will be part of future investigations.

Metal artefact reduction algorithm for correction of bone biopsy needle artefact in paediatric C-arm CT images: a qualitative and quantitative assessment

Metal artefact reduction algorithm for correction of bone biopsy needle artefact in paediatric C-arm CT images: a qualitative and quantitative assessment

Evaluation of C-arm CT metal artifact reduction algorithm during intra-aneurysmal coil embolization: Assessment of brain parenchyma, stents and flow-diverters

PurposeFlat panel C-arm CT images acquired in the interventional suite provide valuable information regarding brain parenchyma, vasculature, and device status during the procedure. However, these images often suffer from severe streak artifacts due to the presence of metallic objects such as coils. These artifacts limit the capability to make diagnostic inferences and thus need to be reduced for better image interpretation. The main purpose of this paper is to systematically evaluate the accuracy of one such C-arm CT based metal artifact reduction (MAR) algorithm and to demonstrate its usage in both stent and flow diverter assisted coil embolization procedures. MethodsC-arm CT images routinely acquired in 24 patients during coil embolization procedure (stent-assisted (12) and flow-diverter assisted (12)) were included in this study in a retrospective fashion. These images were reconstructed without and with MAR algorithm on an offline workstation and compared using quantitative image analysis metrics. This analysis was carried out to assess the improvements in both brain parenchyma and device visibility with MAR algorithm. Further, ground truth reference images from phantom experiments and clinical data were used for accurate assessment. ResultsQuantitative image analysis of brain parenchyma showed uniform distribution of grayscale values and reduced image noise after MAR correction. The line profile plot analysis of device profile in both phantom and clinical data demonstrated improved device visibility with MAR correction. ConclusionsMAR algorithm successfully reduced streak artifacts from coil embolization in all cases, thus allowing more accurate assessment of devices and adjacent brain parenchyma.

Low-Dose Volume-of-Interest C-Arm CT Imaging of Intracranial Stents and Flow Diverters

Volume-of-interest C-arm CT is a novel technique for imaging of intracranial high-contrast objects. We performed this study to evaluate the potential diagnostic value and radiation dose reduction of this technique for imaging of intracranial stents and flow diverters. Twenty-seven patients were imaged with a VOI C-arm CT scan following treatment with a flow diverter or stent-assisted coiling. The radiation dose-area product was recorded for VOI scans. For comparison, the dose-area product from 30 previously acquired consecutive full-view DynaCTs was used. Thermoluminescence dosimetry by using 35 evenly distributed thermoluminescence dosimeters in an anthropomorphic head phantom was also performed by using both conventional full field and VOI acquisitions. Three observers were presented with VOI images for assessment of the potential diagnostic value. The dose-area product measurements showed an exposure reduction of 85% compared with the full field acquisitions used for comparison. The thermoluminescence dosimetry evaluations also showed a considerable dose reduction of 79.8% throughout the volume. For most of the evaluated cases, the observers thought that diagnostically useful information was provided by the VOI images (α = .810). Visualization of device details, such as the extent of opening, positioning, wall apposition, and aneurysm coverage, was judged of good diagnostic quality for most cases (88.9%-92.6%). In this study, VOI C-arm CT provided high-quality diagnostic images of intracranial stents and flow diverters at a dramatic reduction of radiation exposure. Image content was thought to add useful information. It is a promising method to assess device status during procedures and at follow-up.

Intra-operative assessment of fractured articular surfaces in cone beam CT image data.

The assessment of intra-operatively acquired volumetric data is a difficult and often time-consuming task, which demands a new set of skills from the surgeons. In the case of orthopedic surgeries such as the treatment of calcaneal fractures, the correctness of the reduction of the bone fragments can be verified with the help of C-arm CT volumetric images. For an accurate intra-operative assessment of the displaced fragments, an automatic segmentation of the articular surfaces and color-coded visualization was developed. Our automatic approach consists of three major steps: first, using adjusted standard planes intersecting the articular region, the joint space is localized with an intensity profile-based method. In a second step, the localized joint space is segmented on the Laplacian of Gaussian filtered volumetric image by a modified binary flood fill algorithm. Finally, a 3D surface model of the segmented joint space is analyzed and visualized with focus on critical displacements of the surface. A specifically designed human cadaver study consisting of ten lower legs of ten different donors was conducted to acquire 48 realistic C-arm CT images of misaligned bone fragments (steps of varying sizes) in the posterior talar articular surface of the calcaneus. The proposed algorithmic pipeline was verified by the acquired image data and showed very good results with no false positives and an overall correct displacement assessment of 93.8%. The proposed algorithmic pipeline can be easily integrated into the clinical workflow and qualifies for intra-operative usage. It showed very good results on the reference data set of the cadaver study. With the help of such an assistance system, the time-consuming process of 2D view adjustment and visual assessment of the gray value images can be greatly simplified.

Intra-operative adjustment of standard planes in C-arm CT image data.

With the help of an intra-operative mobile C-arm CT, medical interventions can be verified and corrected, avoiding the need for a post-operative CT and a second intervention. An exact adjustment of standard plane positions is necessary for the best possible assessment of the anatomical regions of interest but the mobility of the C-arm causes the need for a time-consuming manual adjustment. In this article, we present an automatic plane adjustment at the example of calcaneal fractures. We developed two feature detection methods (2D and pseudo-3D) based on SURF key points and also transferred the SURF approach to 3D. Combined with an atlas-based registration, our algorithm adjusts the standard planes of the calcaneal C-arm images automatically. The robustness of the algorithms is evaluated using a clinical data set. Additionally, we tested the algorithm's performance for two registration approaches, two resolutions of C-arm images and two methods for metal artifact reduction. For the feature extraction, the novel 3D-SURF approach performs best. As expected, a higher resolution ([Formula: see text] voxel) leads also to more robust feature points and is therefore slightly better than the [Formula: see text] voxel images (standard setting of device). Our comparison of two different artifact reduction methods and the complete removal of metal in the images shows that our approach is highly robust against artifacts and the number and position of metal implants. By introducing our fast algorithmic processing pipeline, we developed the first steps for a fully automatic assistance system for the assessment of C-arm CT images.

Endovascular Recanalization in Acute Ischemic Stroke Using the Solitaire FR Revascularization Device with Adjunctive C-Arm CT Imaging.

In this clinical report, we examined a single-center experience by using the Solitaire FR Revascularization Device in the treatment of acute ischemic stroke in which there was poor initial visualization of the occluded arterial branches by using biplanar cerebral angiography. In all cases, adjunctive C-arm CT was used during the deployment of the thrombectomy device to gain additional information regarding device placement and expansion. Outcome measures included the extent of reperfusion, posttreatment changes in NIHSS scores, posttreatment TICI scores, cerebral hemorrhage, and survival. Clot removal with successful arterial recanalization was achieved in 15/18 cases (83.3%) with TICI scores of 2b/3 in all patients who had initial recanalization. The NIHSS score improved, on average, from 19 pretreatment to 11 posttreatment, and 72% of patients survived. In cases of acute stroke in which there is little information available regarding the positioning and deployment of a retrievable stent during mechanical thrombectomy, the use of C-arm CT may provide more information about device placement across an area of thrombus.

An Integrated Method for XRII Image Distortion Correction

The distorted X-Ray Image Intensifier (XRII) image can introduce negative effect on following work for C-arm CT imaging system. In this paper, we propose an integrated approach based on least squares and Biharmonic spline interpolation to correct geometric distortions of XRII images. The method first uses morphology operation to extract the coordinate values of control points. Then the least square method fits the extracted coordinate values in every row and computes the more coordinate values by fixing the length in every row. Finally, The Biharmonic spline interpolation is used to interpolate the all coordinate values and correct the distortional XRII image. The experiment shows that the integrated method can effectively correct the distorted XRII image.

Registration of 2D C-Arm and 3D CT Images for a C-Arm Image-Assisted Navigation System for Spinal Surgery.

C-Arm image-assisted surgical navigation system has been broadly applied to spinal surgery. However, accurate path planning on the C-Arm AP-view image is difficult. This research studies 2D-3D image registration methods to obtain the optimum transformation matrix between C-Arm and CT image frames. Through the transformation matrix, the surgical path planned on preoperative CT images can be transformed and displayed on the C-Arm images for surgical guidance. The positions of surgical instruments will also be displayed on both CT and C-Arm in the real time. Five similarity measure methods of 2D-3D image registration including Normalized Cross-Correlation, Gradient Correlation, Pattern Intensity, Gradient Difference Correlation, and Mutual Information combined with three optimization methods including Powell's method, Downhill simplex algorithm, and genetic algorithm are applied to evaluate their performance in converge range, efficiency, and accuracy. Experimental results show that the combination of Normalized Cross-Correlation measure method with Downhill simplex algorithm obtains maximum correlation and similarity in C-Arm and Digital Reconstructed Radiograph (DRR) images. Spine saw bones are used in the experiment to evaluate 2D-3D image registration accuracy. The average error in displacement is 0.22 mm. The success rate is approximately 90% and average registration time takes 16 seconds.

Abstract 20183: Intraprocedural C-Arm CT Imaging Identifies Incomplete Stent Frame Expansion in Self-Expanding Aortic Valve Prostheses Associated With Perivalvular Aortic Regurgitation

Introduction: Transcatheter aortic valve replacement has revolutionized the treatment of severe aortic stenosis, but post implantation perivalvular aortic regurgitation may result in increased mortality. Hypothesis: The purpose of this study was to identify structural abnormalities in the frame of self-expanding aortic valve prostheses (CoreValve®, Medtronic, Minneapolis, MN) immediately following implantation and evaluate their relationship to subsequent perivalvular aortic regurgitation severity. Methods/Results: After implantation of CoreValve, 14 patients with evidence of frame deformation by fluoroscopy underwent intraprocedural C-arm CT imaging (syngo DynaCT®, Siemens Medical Solutions, USA) acquired using 5-s, 200° rotation under breath-hold and rapid right ventricular pacing (120-140bpm). CT-like multi-planar reconstructions (Figure) were performed; perimeter (P), maximum (Dmax) and minimum (Dmin) diameters of the CoreValve frame were measured at multiple levels (0mm, 8mm, 16mm) orthogonal to the longitudinal axis. Ellipticity index (EI) was measured as Dmax divided by Dmin. Color Doppler transthoracic echo was performed the day following valve implantation to assess perivalvular regurgitation. One-way ANOVA demonstrated that degree of perivalvular aortic regurgitation was significantly related to valve frame perimeter underexpansion at the inferior margin of the frame (20.8% [17.2-25.7%], p=0.011) and increased ellipticity index both at the 8mm above the edge of the frame (1.4, [1.3-1.5], p=0.012) and 16mm above the edge of the frame (1.4, [1.3-1.5], p=0.038). Conclusions: Intraprocedural DynaCT effective at determining aortic valve frame deformations in 3D, which was associated with increased perivalvular aortic regurgitation, and may provide a method for risk stratifying post-implantation aortic regurgitation and need for additional procedural maneuvers such as post-stent dilation or additional revalving.

P-005 Evaluation of an Automatic Detection and Segmentation Tool for Flow Diverters (Pipeline™ Embolization Device) from C-arm CT Images

PurposeIn addition to stent-assisted coiling, endovascular treatment of intracranial aneurysms using flow diverters, like the Pipeline™ Embolization Device (PED), has become a viable treatment option. Visualization of the device after...

O-001 A Novel Metal Artefact Removal Software for C-arm CT; A Novel Imaging Modality to Analyze Aneurysms Treated with Stent Assisted Coil Embolization

PurposeStent assisted coil embolization recently became a common treatment strategy for the wide neck aneurysms. Normal digital subtraction angiography (DSA), however, does not allow visualization of the deployed stents. With...

First pass cable artefact correction for cardiac C-arm CT imaging

Cardiac C-arm CT imaging delivers a tomographic region-of-interest reconstruction of the patient's heart during image guided catheter interventions. Due to the limited size of the flat detector a volume image is reconstructed, which is truncated in the cone-beam (along the patient axis) and the fan-beam (in the transaxial plane) direction. To practically address this local tomography problem correction methods, like projection extension, are available for first pass image reconstruction. For second pass correction methods, like metal artefact reduction, alternative correction schemes are required when the field of view is limited to a region-of-interest of the patient. In classical CT imaging metal artefacts are corrected by metal identification in a first volume reconstruction and generation of a corrected projection data set followed by a second reconstruction. This approach fails when the metal structures are located outside the reconstruction field of view. When a C-arm CT is performed during a cardiac intervention pacing leads and other cables are frequently positioned on the patients skin, which results in propagating streak artefacts in the reconstruction volume. A first pass approach to reduce this type of artefact is introduced and evaluated here. It makes use of the fact that the projected position of objects outside the reconstruction volume changes with the projection perspective. It is shown that projection based identification, tracking and removal of high contrast structures like cables, only detected in a subset of the projections, delivers a more consistent reconstruction volume with reduced artefact level. The method is quantitatively evaluated based on 50 simulations using cardiac CT data sets with variable cable positioning. These data sets are forward projected using a C-arm CT system geometry and generate artefacts comparable to those observed in clinical cardiac C-arm CT acquisitions. A C-arm CT simulation of every cardiac CT data set without cables served as a ground truth. The 3D root mean square deviation between the simulated data set with and without cables could be reduced for 96% of the simulated cases by an average of 37% (min −9%, max 73%) when using the first pass correction method. In addition, image quality improvement is demonstrated for clinical whole heart C-arm CT data sets when the cable removal algorithm was applied.