Presence Of Metal Artifacts Research Articles

Effect of Metal Artifacts in Cone-beam Computed Tomography on Accuracy of Implant Placement by Static and Dynamic Computer- Assisted Implant Surgery: An In Vitro Study.

This study evaluates the impact of metal artifacts in cone-beam computed tomography (CBCT) on the accuracy of static and dynamic computer-assisted implant surgery (CAIS) techniques. An implant was placed on each of thirty 3D-printed models embedded with Cobalt-Chrome strips to simulate metal artifacts by Porcelain-fused-to-metal (PFM), utilizing these CAIS techniques: radiographic template (RT) (n=10), radiographic markers (RM) (n=10), and dynamic navigation (DN) (n=10). Trueness and precision were analyzed by comparing 3D global deviation and the difference in implant positions at the neck, apex, depth, and angle in initial planned and final placed scans. DN exhibited significantly lower 3D global trueness deviation to RT (p = 0.022) and lower angular deviation compared to both RT (p = 0.003) and RM (p = 0.002). RM showed greater trueness at the implant neck compared to DN (p = 0.005) and better depth trueness than RT (p = 0.001) and DN (p = 0.027). DN demonstrated higher precision in implant angulation than RM (p = 0.011) and RT (p = 0.041). In the presence of metal artifacts, both DN and RM techniques offered greater trueness in specific implant positions compared to RT. However, DN proved to be the most precise method for implant placement.

Iodine concentration, HU accuracy, and metal artifacts evaluation on second-generation dual-layer spectral detector CT images with metal implants: a phantom study.

Metal implants may affect the image quality, iodine concentration (IC), and CT Hounsfield unit (HU) quantification accuracy. To investigate the quantitative accuracy of IC and HU from dual-layer spectral detector (DLCT) in the presence of metal artifacts. An experimental cylindrical phantom containing eight iodine inserts and two metal inserts was designed. The phantom underwent scanning at three radiation dose levels and two tube voltage settings. A set of conventional images (CIs), virtual monoenergetic images (VMIs), and iodine concentration maps (ICMs) were generated and measured for all the eight iodine inserts. Quantitative indicators of mean absolute percentage error (MAPE), artifact index (AI), contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and standard deviation (SD) on CIs and VMIs were calculated for IC and HU. Subjective score evaluation was also conducted. The MAPEiodine values of all regions of interest across different scanning configurations were all <5%. Almost all APEiodine values were <5%, indicating that metal artifacts had little impact on IC measurements. When the tube voltage was fixed, the SD value of attenuation decreased with the increase of the tube current; this is also true when the tube current was fixed. The middle energy reconstructions seemed to give a good balance between reducing artifacts and improving contrast. VMIs from DLCT can reduce metal artifacts, the accuracy of IC quantification is not sensitive to imaging parameters. In summary, metal implants exhibit minimal impact on image quality and IC quantification accuracy in reconstructed images from DLCT.

Accuracy of cone-beam computed tomography in imaging the components of the periodontal phenotype.

The components and dimensions of the periodontal and peri-implant phenotype have a high relevance in contemporary dental research and should be taken into consideration in the decision-making process in the management of a variety of clinical scenarios to optimize the outcomes of therapy. Various assessment methods for quantifying and classifying the phenotypical dimensions have emerged and developed in recent decades. Nevertheless, the use of cone-beam computed tomography (CBCT) scans remains the most commonly used approach worldwide. However, the accuracy to adequately imaging and measuring the dimensions of the hard and soft tissue components around teeth may represent a significant challenge in different clinical scenarios due to factors such as the age of the patient and motion during the scan, presence of metallic artifacts causing streaks and gray-value distortion, overlapping of soft tissue structures, machine performance, file processing, and small voxel size among others. These factors pose a particular challenge when tiny structures are under investigation, for example, the buccal/lingual bony or soft tissue layer of lower/upper incisors. Therefore, this review addresses the underlying technical information of the use of CBCT scans, and suggests some recommendations on the utilization of this method of assessment to optimally use it despite its' system-inherent limitations.

Triple-energy virtual monochromatic imaging with a photon-counting detector for reducing metal artifacts in half-beam dental computed tomography

Dental computed tomography (DCT) is crucial for accurate diagnosis and treatment planning in modern dental care. However, the presence of metal artifacts from dental restorations or implants often compromises the image quality. This study introduces and evaluates a novel technique, triple-energy virtual monochromatic imaging (TEVM), which employs a photon-counting detector (PCD) to enhance image quality. TEVM synthesizes images captured at three distinct energy levels to produce a virtual monochromatic image (VMI) with improved contrast and sharpness, particularly in areas affected by metal artifacts. We compared the efficacy of TEVM in mitigating metal artifacts using half-beam dental and endodontic CT with that of conventional methods. The results indicate that TEVM significantly reduces metal artifacts and improves image quality. In addition, this technique minimizes the need for repeated scans, thereby reducing radiation exposure. In conclusion, TEVM combined with PCD offers a promising avenue for overcoming the challenges posed by metal artifacts in dental and endodontic CT, thereby enhancing both diagnostic accuracy and patient care.

Development and validation of a 3D anthropomorphic phantom for dental CBCT imaging research.

Optimization of dental cone beam computed tomography (CBCT) imaging is still in a preliminary stage and should be addressed using task-based methods. Dedicated models containing relevant clinical tasks for image quality studies have yet to be developed. To present a methodology to develop and validate a virtual adult anthropomorphic voxel phantom for use in task-based image quality optimization studies in dental CBCT imaging research, focusing on root fracture (RF) detection tasks in the presence of metal artefacts. The phantom was developed from a CBCT scan with an isotropic voxel size of 0.2mm, from which the main dental structures, mandible and maxilla were segmented. The missing large anatomical structures, including the spine, skull and remaining soft tissues, were segmented from a lower resolution full skull scan. Anatomical abnormalities were absent in the areas of interest. Fine detailed dental structures, that could not be segmented due to the limited resolution and noise in the clinical data, were modelled using a-priori anatomical knowledge. Model resolution of the teeth was therefore increased to 0.05mm. Models of RFs as well as dental restorations to create the artefacts, were developed, and could be inserted in the phantom in any desired configuration. Simulated CBCT images of the models were generated using a newly developed multi-resolution simulation framework that incorporated the geometry, beam quality, noise and spatial resolution characteristics of a real dental CBCT scanner. Ray-tracing and Monte Carlo techniques were used to create the projection images, which were reconstructed using the classical FDK algorithm. Validation of the models was assessed by measurements of different tooth lengths, the pulp volume and the mandible, and comparison with reference values. Additionally, the simulated images were used in a reader study in which two oral radiologists had to score the realism level of the model's normal anatomy, as well as the modelled RFs and restorations. A model of an adult head, as well as models of RFs and different types of dental restorations were created. Anatomical measurements were consistent with ranges reported in literature. For the tooth length measurements, the deviations from the mean reference values were less than 20%. In 77% of all the measurements, the deviations were within 10.1%. The pulp volumes, and mandible measurements were within one standard deviation of the reference values. Regarding the normal anatomy, both readers considered the realism level of the dental structures to be good. Background structures received a lower realism score due to the lack of detailed enough trabecular bone structure, which was expected but not the focus of this study. All modelled RFs were scored at least adequate by at least one of the readers, both in appearance and position. The realism level of the modelled restorations was considered to be good. A methodology was proposed to develop and validate an anthropomorphic voxel phantom for image quality optimization studies in dental CBCT imaging, with a main focus on RF detection tasks. The methodology can be extended further to create more models representative of the clinical population.

Cone-Beam CT With Enhanced Needle Guidance and Augmented Fluoroscopy Overlay: Applications in Interventional Radiology.

Digital flat-panel detector cone-beam CT (CBCT), introduced in the early 2000s, was historically used in interventional radiology primarily for liver-directed therapies. However, contemporary advanced imaging applications, including enhanced needle guidance and augmented fluoroscopy overlay, have evolved substantially over the prior decade and now work synergistically with CBCT guidance to overcome limitations encountered with other imaging modalities. CBCT with advanced imaging applications has become increasingly used to facilitate a broad range of minimally invasive procedures, particularly relating to pain and musculoskeletal interventions. Potential advantages of CBCT with advanced imaging applications include greater accuracy for complex needle paths, improved targeting in the presence of metal artifact, enhanced visualization during injection of contrast medium or cement, increased ease when space in the gantry is limited, and reduced radiation doses versus conventional CT guidance. Nonetheless, CBCT guidance remains underutilized, partly relating to lack of familiarity with the technique. This article describes the practical implementation of CBCT with enhanced needle guidance and augmented fluoroscopy overlay and depicts the technique's application for an array of interventional radiology procedures, including epidural steroid injections, celiac plexus block and neurolysis, pudendal block, spine ablation, percutaneous osseous ablation fixation and osteoplasty, biliary recanalization, and transcaval type II endoleak repair.

Ultrashort Echo Time Magnetic Resonance Angiography as an Alternative Tool to Digital Subtraction Angiography in the Follow-up of Stent-Assisted Coil Embolization Outcomes.

Follow-up of aneurysms treated with stent-assisted coil embolization has been performed using digital subtraction angiography (DSA) because in time-of-flight magnetic resonance angiography, metal artifacts from the stent often affect visualization. To confirm whether ultrashort echo time (TE) MRA may be an alternative for DSA during follow-up. Patients with unruptured aneurysms initially treated with stent-assisted coil embolization between April 2019 and March 2021 were enrolled. After 3 months of treatment, follow-up DSA and ultrashort TE MRA were performed. All images were independently reviewed by neurosurgeons to evaluate in-stent flow and rated from 1 (not visible) to 4 (excellent). Aneurysmal embolization status was assessed as complete obliteration, residual neck, or residual aneurysm. Ultrashort TE MRA findings were classified as evaluative or nonevaluative state based on the presence of metal artifacts. We investigated the types of aneurysms that were evaluative and the agreement between ultrashort TE and DSA. Overall, 89 aneurysms were examined, of which 74% (n = 66) were classified as evaluative on ultrashort TE. Significant differences were observed in size and stent type. Evaluative cases had an aneurysm size of <7 mm ( P = .0007) and a higher rate of Neuroform Atlas ( P = .0006). The rate of agreement between ultrashort TE with evaluative state and DSA was 95%. Ultrashort TE MRA could evaluate an embolization status treated with stenting, and the findings are in excellent agreement with those of DSA. Aneurysms measuring <7 mm and treated with Neuroform Atlas are evaluative on ultrashort TE, and DSA might not be necessary.

Deep convolutional neural network-based automated segmentation and classification of teeth with orthodontic brackets on cone-beam computed-tomographic images: a validation study.

Tooth segmentation and classification from cone-beam computed tomography (CBCT) is a prerequisite for diagnosis and treatment planning in the majority of digital dental workflows. However, an accurate and efficient segmentation of teeth in the presence of metal artefacts still remains a challenge. Therefore, the following study aimed to validate an automated deep convolutional neural network (CNN)-based tool for the segmentation and classification of teeth with orthodontic brackets on CBCT images. A total of 215 CBCT scans (1780 teeth) were retrospectively collected, consisting of pre- and post-operative images of the patients who underwent combined orthodontic and orthognathic surgical treatment. All the scans were acquired with NewTom CBCT device. A complete dentition with orthodontic brackets and high-quality images were included. The dataset were randomly divided into three subsets with random allocation of all 32 tooth classes: training set (140 CBCT scans-400 teeth), validation set (35 CBCT scans-100 teeth), and test set (pre-operative: 25, post-operative: 15 = 40 CBCT scans-1280 teeth). A multiclass CNN-based tool was developed and its performance was assessed for automated segmentation and classification of teeth with brackets by comparison with a ground truth. The CNN model took 13.7 ± 1.2 s for the segmentation and classification of all the teeth on a single CBCT image. Overall, the segmentation performance was excellent with a high intersection over union (IoU) of 0.99. Anterior teeth showed a significantly lower IoU (P < 0.05) compared to premolar and molar teeth. The dice similarity coefficient score of anterior (0.99 ± 0.02) and premolar teeth (0.99 ± 0.10) in the pre-operative group was comparable to the post-operative group. The classification of teeth to the correct 32 classes had a high recall rate (99.9%) and precision (99%). The proposed CNN model outperformed other state-of-the-art algorithms in terms of accuracy and efficiency. It could act as a viable alternative for automatic segmentation and classification of teeth with brackets. The proposed method could simplify the existing digital workflows of orthodontics, orthognathic surgery, restorative dentistry, and dental implantology by offering an accurate and efficient automated segmentation approach to clinicians, hence further enhancing the treatment predictability and outcomes.

Evaluation of bone mineral density after instrumented lumbar fusion with computed tomography

Computed tomography (CT) measurement of Hounsfield Units (HU) has been described as a tool for assessing BMD. For surgeons considering a revision lumbar fusion, knowledge of the BMD of the UIV is of value for surgical planning. However, the presence of metal artifact from instrumentation presents a potential confounder, and prior studies have not validated measurements of HU in this setting. To determine if HU can be measured reliably at the supra-adjacent and upper instrumented levels of a lumbar fusion. Retrospective observational cohort PATIENT SAMPLE: Consecutive series of patients who had lumbar CT scans after an instrumented posterior lumbar fusion. Hounsfield Units at the upper instrumented vertebra and levels proximal. We analysed pre- and postoperative CT scans of 50 patients who underwent L2 and distal instrumented lumbar fusion whose scans were no greater than 1 year apart, obtaining HU measurements of analogous axial cuts at the upper instrumented level (immediately caudal to the halo of the pedicle screw), as well as additional control levels above the construct. The HU at the pre-and postoperative UIV exhibited a strong correlation (r=0.917, p<.001), as did one (r=0.887, p<.001) and two (r=0.853, p<.001) levels above the UIV. There were significant but predictable reductions in the postoperative HU compared to preoperative at one (-9.0±26.2) and two (-12.2±30.2) levels above the UIV, as well as T12 (-13.9±42.2). There was no significant difference in HU at the UIV (4.6±34.1). Postoperative HU at the UIV was strongly correlated with and not significantly different from the preoperative HU. Although the HU in the vertebrae proximal to the UIV were slightly lower postoperatively, this change was predictable using a correction factor.

Impact of metal artefacts on subjective perception of image quality of 13 CBCT devices

The overall objective of this study was to assess how metal artefacts impact image quality of 13 CBCT devices. As a secondary objective, the influence of scanning protocols and field of view on CBCT image quality with and without metal artefacts was also assessed. CBCT images were acquired of a dry human skull phantom considering three clinical simulated conditions: one without metal and two with metallic materials (metallic pin and implant). An industrial micro-CT was used as a reference to register the CBCT images. Afterwards, four observers evaluated 306 representative image slices from 13 devices, ranking them from best to worst. Furthermore, within each device, medium FOV and small FOV standard images were compared. General linear mixed models were used to assess subjective perception of examiners on overall image quality in the absence and presence of metal-related artefacts (p < 0.05). Image quality perception significantly differed amongst CBCT devices (p < 0.05). Some devices performed significantly better, independently of scanning protocol and clinical condition. In the presence of metal artefacts, medium FOV standard scanning protocols scored significantly better, while in the absence of metal, small FOV standard yielded the highest performance. Subjective image quality differs significantly amongst CBCT devices and scanning protocols. Metal-related artefacts may highly impact image quality, with a significant device-dependent variability and only few scanners being more robust against metal artefacts. Often, metal artefact expression may be somewhat reduced by proper protocol selection. Metallic objects may severely impact image quality in several CBCT devices.

Measurement Accuracy in Cone Beam Computed Tomography in the Presence of Metal Artifact.

Cone beam computed tomography (CBCT) image quality is known to be affected by artifacts produced by metal restorations, causing image deterioration via bright streaks and loss of gray values in the vicinity of the metallic structure. The aim of the study was to determine the impact of progressively increasing metal artifacts on the measurement accuracy of commonly evaluated points in implant treatment planning. Holes were drilled into porcine mandibles at known distances from the alveolar crest on the buccal and lingual surfaces and filled with gutta-percha. Repeated CBCT images were taken, with progressively increasing amalgam restorations and stainless steel crowns (up to a total of eight restorations per jaw). The imaging field of view (FOV) was of a single site (5 × 5 cm2) in two different locations in the mandible, as well as a full-arch FOV (10 × 5 cm2). Images were taken using clinical settings, and with increased kVp and exposure time, without metal artifact reduction (MAR) corrections. Measurements between the buccal and lingual gutta-percha points on the mandible were performed using a digital caliper and compared to the same measurements taken digitally on the CBCT images. Measurements were obtained with no restorations (baseline) and compared with increasing number of restorations. Comparison between caliper measurements and baseline CBCT with no metal artifact demonstrated differences ranging from 0 to 1.7 mm, with no clear detectable pattern of change related to the restorations. Compared to baseline measurements, scans with amalgam and stainless steel restorations showed a maximum difference of 0.54 ± 0.64 mm and 0.62 ± 0.64 mm, respectively, with no significant differences with increasing metal restorations. There may be a variation of up to 1.7 mm between measured anatomical points and CBCT imaging under commonly used settings. While this result may be clinically important, it does not appear to be affected by increasing metal artifact due to amalgam restorations or stainless steel crowns. The findings of this study support current clinical practices accounting for a safety margin of up to 2 mm with any CBCT image, and not limiting CBCT scans for patients with multiple metal restorations.

263. Evaluation of bone mineral density after instrumented lumbar fusion using computed tomography

<h3>BACKGROUND CONTEXT</h3> Computed tomography (CT) measurement of Hounsfield Units (HU) has been described as a tool for assessing bone mineral density (BMD). For surgeons considering a revision lumbar fusion, knowledge of the BMD of the upper instrumented verterbra (UIV) is of value for surgical planning. However, the presence of metal artifact from instrumentation presents a potential confounder and prior studies have not validated measurements of HU in this setting. <h3>PURPOSE</h3> The purpose of this study is to determine if HU can be measured reliably at instrumented levels after a lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective observational cohort at a single multisurgeon spine center. <h3>PATIENT SAMPLE</h3> Consecutive series of patients who had lumbar CT Scans after an instrumented posterior lumbar fusion. <h3>OUTCOME MEASURES</h3> Hounsfield Units at the upper instrumented vertebra and levels proximal. <h3>METHODS</h3> We analyzed pre- and postoperative CT scans of 50 patients who underwent L2 and distal instrumented lumbar fusion whose scans were no greater than 1 year apart, obtaining HU measurements of analogous axial cuts at the upper instrumented level (immediately caudal to the halo of the pedicle screw), as well as additional control levels above the construct. <h3>RESULTS</h3> The HU at the pre-and postoperative UIV exhibited a strong correlation (r=0.917, p <0.001), as did one (r=0.887, p <0.001) and two (r=0.853, p <0.001) levels above the UIV. There were significant but predictable reductions in the postoperative HU compared to preoperative at one (-9.0 ± 26.2) and two (-12.2 ± 30.2] levels above the UIV, as well as T12 (-13.9 ± 42.2). There was no significant difference in HU at the UIV (4.6 ± 34.1). <h3>CONCLUSIONS</h3> Postoperative HU at the UIV was strongly correlated with and not significantly different from the preoperative HU. Although the HU in the vertebrae proximal to the UIV were slightly lower postoperatively, this change was predictable using a correction factor. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

EVALUATION OF CBCT SCANS WITH METALLIC ARTIFACTS FOR ASSESSMENT OF DIAGNOSTIC QUALITY

<h3>Background</h3> Cone beam computed tomography (CBCT) is increasingly being used in dentistry for diagnosis and treatment planning. However, the presence of metals in the form of coronal restorations, implants, and endodontic post and cores results in the generation of artifacts. Beam hardening artifacts, streaks, and scatter are the main types of metallic artifacts and, when present, cause image degradation that may compromise the accuracy of diagnosis. Depending on the severity of the artifact and the diagnostic task, images may be unusable. <h3>Objective(s)</h3> The objective of this study was to retrospectively evaluate CBCT scans with metallic artifacts and assess whether or not the presence of metal affects diagnosis of a specific entity. <h3>Study Design</h3> A total of 105 scans from the archives of the Department of Oral and Maxillofacial Radiology at University of Connecticut, School of Dental Medicine, were evaluated for this study. The scans were divided into 3 groups comprising referrals for implant site evaluation, for endodontic evaluation for root canal morphologies/anatomy, and for crown/root fractures, respectively. Inclusion criteria were scans that had metallic artifacts. The scans were analyzed to determine if these artifacts positively or negatively influenced diagnosis. All images were evaluated by a radiology resident in training (K.B.) and a board certified Oral and Maxillofacial Radiologist (A.T.). <h3>Results</h3> Of the scans analyzed for implant treatment planning, 100% were deemed to be of diagnostic quality. For root canal morphology and anatomy, 94% were adequate for diagnosis, whereas 6% were not. For evaluation of fractures, 63% were adequate for diagnosis, and 37% were not adequate for diagnosis. <h3>Discussion/Conclusions</h3> In this study, a large percentage of the scans were adequate for diagnosis despite the presence of metallic artifacts except for root fractures.

Biological fingerprint using scout computed tomographic images for positive patient identification.

Management of patient identification is an important issue that should be addressed to ensure patient safety while using modern healthcare systems. Patient identification errors can be mainly attributed to human errors or system problems. An error-tolerant system, such as a biometric system, should be able to prevent or mitigate potential misidentification occurrences. Herein, we propose the use of scout computed tomography (CT) images for biometric patient identity verification and present the quantitative accuracy outcomes of using this technique in a clinical setting. Scout CT images acquired from routine examinations of the chest, abdomen, and pelvis were used as biological fingerprints. We evaluated the resemblance of the follow-up with the baseline image by comparing the estimates of the image characteristics using local feature extraction and matching algorithms. The verification performance was evaluated according to the receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and equal error rates (EER). The closed-set identification performance was evaluated according to the cumulative match characteristic curves and rank-one identification rates (R1). A total of 619 (383 males, 236 females, age range 21-92years) patients who underwent baseline and follow-up chest-abdomen-pelvis CT scans on the same CT system were analyzed for verification and closed-set identification. The highest performances of AUC, EER, and R1 were 0.998, 1.22%, and 99.7%, respectively, in the considered evaluation range. Furthermore, to determine whether the performance decreased in the presence of metal artifacts, the patients were classified into two groups, namely scout images with (255 patients) and without (364 patients) metal artifacts, and the significance test was performed for two ROC curves using the unpaired Delong's test. No significant differences were found between the ROC performances in the presence and absence of metal artifacts when using a sufficient number of local features. Our proposed technique demonstrated that the performance was comparable to that of conventional biometrics methods when using chest, abdomen, and pelvis scout CT images. Thus, this method has the potential to discover inadequate patient information using the available chest, abdomen, and pelvis scout CT image; moreover, it can be applied widely to routine adult CT scans where no significant body structure effects due to illness or aging are present. Our proposed method can obtain accurate patient information available at the point-of-care and help healthcare providers verify whether a patient's identity is matched accurately. We believe the method to be a key solution for patient misidentification problems.

In vivo accuracy of tooth surface reconstruction based on CBCT and dental MRI-A clinical pilot study.

Guided implant surgery (GIS) requires alignment of virtual models to reconstructions of three-dimensional imaging. Accurate visualization of the tooth surfaces in the imaging datasets is mandatory. In this prospective clinical study, in vivo tooth surface accuracy was determined for GIS using cone-beam computed tomography (CBCT) and dental magnetic resonance imaging (dMRI). CBCT and 3-Tesla dMRI were performed in 22 consecutive patients (mean age: 54.4±15.2years; mean number of restorations per jaw: 6.7±2.7). Altogether, 92 teeth were included (31 incisor, 29 canines, 20 premolars, and 12 molars). Surfaces were reconstructed semi-automatically and registered to a reference standard (3D scans of stone models made from full-arch polyether impressions). Reliability of both methods was assessed using intraclass correlation coefficients. Accuracy was evaluated using the two one-sided tests procedure with a predefined equivalence margin of ±0.2mm root mean square (RMS). Inter- and intrarater reliability of tooth surface reconstruction were comparable for CBCT and dMRI. Geometric deviations were 0.102±0.042mm RMS for CBCT and 0.261±0.08mm RMS for dMRI. For a predefined equivalence margin, CBCT and dMRI were statistically equivalent. CBCT, however, was significantly more accurate (p≤.0001). For both imaging techniques, accuracy did not differ substantially between different tooth types. Cone-beam computed tomography is an accurate and reliable imaging technique for tooth surfaces in vivo, even in the presence of metal artifacts. In comparison, dMRI in vivo accuracy is lower. Still, it allows for tooth surface reconstruction in satisfactory detail and within acceptable acquisition times.

Higher Resolution in Cone Beam Computed Tomography Is Accompanied by Improved Bone Detection in Peri-implant Bone Despite Metal Artifact Presence.

The aim of this study was to determine the possibility and extent of artifact reduction by an optimized use of cone beam computed tomography (CBCT) parameter configuration (geometric resolution, implant geometric parameters, and image analyses). It furthermore sought to determine the distance from correctly reproduced bone tissue to an implant, where the grayscale values are equal to the pre-implantation values. Titanium implants were inserted into pig tibia under standardized conditions. CBCT investigations in the form of bone density mapping were performed under various CBCT settings and implantation situations. The circumference of the implants was measured in order to determine the extent of metal artifacts. This was done by determining grayscale and comparing it to the bone area prior to implantation. Using CBCT to determine bone density postimplantation showed a correlation in dependence of CBCT parameter configuration. Higher resolution led to a better detection of correct bone density values in the peri-implant region. Normal bone density values can be recognized at a distance of 370 μm from the implant surface, when the spatial resolution is 125 μm. Therefore, higher resolution in CBCT is accompanied by an improved bone detection in peri-implant bone, despite the presence of metal artifacts. Peri-implant bone defects that extend 400 μm around implants were reliably detected by using a spatial resolution of 125 μm. In specimens, where multiple implants are present in one line, pronounced artifact formations were present. The artifacts were visible as a combination of streak-like hardening and extinction effects. Bone geometric data and density values may be determined correctly in close proximity to the implant surface, and can detect peri-implant bone defects. When multiple implants are placed, the implant radiation direction geometry must be considered.

The impact of smart metal artefact reduction algorithm for use in radiotherapy treatment planning.

The presence of metal artefacts in computed tomography (CT) create issues in radiation oncology. The loss of anatomical information and incorrect Hounsfield unit (HU) values produce inaccuracies in dose calculations, providing suboptimal patient treatment. Metal artefact reduction (MAR) algorithms were developed to combat these problems. This study provides a qualitative and quantitative analysis of the "Smart MAR" software (General Electric Healthcare, Chicago, IL, USA), determining its usefulness in a clinical setting. A detailed analysis was conducted using both patient and phantom data, noting any improvements in HU values and dosimetry with the GE-MAR enabled. This study indicates qualitative improvements in severity of the streak artefacts produced by metals, allowing for easier patient contouring. Furthermore, the GE-MAR managed to recover previously lost anatomical information. Additionally, phantom data showed an improvement in HU value with GE-MAR correction, producing more accurate point dose calculations in the treatment planning system. Overall, the GE-MAR is a useful tool and is suitable for clinical environments.

Quantitative analysis of orthopedic metal artefact reduction in 64-slice computed tomography scans in large head metal-on-metal total hip replacement, a phantom study.

PurposeQuantification of the effect of O-MAR on decreasing metal artefacts caused by large head metal on metal total hip arthroplasty (MoM THA) in a dedicated phantom setup of the hip.BackgroundPathological reactions of the hip capsule on Computed tomography (CT) can be difficult to diagnose due to different metal artefacts. The O-MAR algorithm deploys an iterative loop where the metal sinogram is identified, extracted, and subsequently serves as a mask to correct the measured sinogram. Main goal of this study is to quantify the ability of the O-MAR technique to correct deviation in medullary bone attenuation caused by streak artefacts from the large-head MoM THA embedded in a phantom. Secondary goal is to evaluate the influence of O-MAR on CNR.MethodsThe phantom was designed as a Perspex box (PMMA) containing water and a supplementary MOM THA surrounded by Perspex columns comprising calibrated calcium pellets. Each column contains 200 mg of hydroxyapatite/calcium carbonate to simulate healthy bone tissue. Scans were obtained with and without a MoM THA at different dose levels. Different reconstructions were made with filter A, iDose4 level 5 and with and without O-MAR. The scans without the prosthesis were used as the baseline. Information about the attenuation in Hounsfield units, image noise in standard deviation within the ROI’s were extracted and the CNR was calculated.ResultsPellet L0 and R0 (proximal of the MoM THA) were defined as reference, lacking any disturbance by metal artefacts; L5, L6 and L8 were respectively visually categorized as ‘light’ ‘medium’ and ‘heavy disturbance’. Significant improvements in attenuation deviation caused by metal artefact were 43, 68 and 32 %, for respectively pellet L5, L6 and L8 (p < 0.001). Significant CNR improvements were present for L5 and L6 and were respectively 72 and 52 % (p < 0.001). O-MAR showed no improvement on CNR for L8.ConclusionThis phantom study significantly increases image quality by the use of O-MAR in the presence of metal artefacts by significantly reducing metal artefacts subsequently and increasing CNR on a 64 slice CT system in light and medium disturbance of the image.

Ex vivo evaluation of new 2D and 3D dental radiographic technology for detecting caries.

Proximal dental caries remains a prevalent disease with only modest detection rates by current diagnostic systems. Many new systems are available without controlled validation of diagnostic efficacy. The objective of this study was to evaluate the diagnostic efficacy of three potentially promising new imaging systems. This study evaluated the caries detection efficacy of Schick 33 (Sirona Dental, Salzburg, Austria) intraoral digital detector images employing an advanced sharpening filter, Planmeca ProMax(®) (Planmeca Inc., Helsinki, Finland) extraoral "panoramic bitewing" images and Sirona Orthophos XG3D (Sirona Dental) CBCT images with advanced artefact reduction. Conventional photostimulable phosphor images served as the control modality. An ex vivo study design using extracted human teeth, ten expert observers and micro-CT ground truth was employed. Receiver operating characteristic analysis indicated similar diagnostic efficacy of all systems (ANOVA p > 0.05). The sensitivity of the Schick 33 images (0.48) was significantly lower than the other modalities (0.53-0.62). The specificity of the Planmeca images (0.86) was significantly lower than Schick 33 (0.96) and XG3D (0.97). The XG3D showed significantly better cavitation detection sensitivity (0.62) than the other modalities (0.48-0.57). The Schick 33 images demonstrated reduced caries sensitivity, whereas the Planmeca panoramic bitewing images demonstrated reduced specificity. XG3D with artefact reduction demonstrated elevated sensitivity and specificity for caries detection, improved depth accuracy and substantially improved cavitation detection. Care must be taken to recognize potential false-positive caries lesions with Planmeca panoramic bitewing images. Use of CBCT for caries detection must be carefully balanced with the presence of metal artefacts, time commitment, financial cost and radiation dose.

Precision of image-based registration for intraoperative navigation in the presence of metal artifacts: Application to corrective osteotomy surgery

Navigation for corrective osteotomy surgery requires patient-to-image registration. When registration is based on intraoperative 3-D cone-beam CT (CBCT) imaging, metal landmarks may be used that deteriorate image quality. This study investigates whether metal artifacts influence the precision of image-to-patient registration, either with or without intermediate user intervention during the registration procedure, in an application for corrective osteotomy of the distal radius. A series of 3-D CBCT scans is made of a cadaver arm with and without metal landmarks. Metal artifact reduction (MAR) based on inpainting techniques is used to improve 3-D CBCT images hampered by metal artifacts. This provides three sets of images (with metal, with MAR, and without metal), which enable investigating the differences in precision of intraoperative registration. Gray-level based point-to-image registration showed a better correlation coefficient if intraoperative images with MAR are used, indicating a better image similarity. The precision of registration without intermediate user intervention during the registration procedure, expressed as the residual angulation and displacement error after repetitive registration was very low and showed no improvement when MAR was used. By adding intermediate user intervention to the registration procedure however, precision was very high but was not affected by the presence of metal artifacts in the specific application.