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All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

SU-E-T-329: Dosimetric Impact of Implementing Metal Artifact Reduction Methods and Metal Energy Deposition Kernels for Photon Dose Calculations

Purpose: To investigate two strategies for reducing dose calculation errors near metal implants: use of CT metal artifact reduction methods and implementation of metal-based energy deposition kernels in the convolution/superposition (C/S) method. Methods: Radiochromic film was used to measure the dose upstream and downstream of titanium and Cerrobend implants. To assess the dosimetric impact of metal artifact reduction methods, dose calculations were performed using baseline, uncorrected images and metal artifact reduction Methods: Philips O-MAR, GE’s monochromatic gemstone spectral imaging (GSI) using dual-energy CT, and GSI imaging with metal artifact reduction software applied (MARs).To assess the impact of metal kernels, titanium and silver kernels were implemented into a commercial collapsed cone C/S algorithm. Results: The CT artifact reduction methods were more successful for titanium than Cerrobend. Interestingly, for beams traversing the metal implant, we found that errors in the dimensions of the metal in the CT images were more important for dose calculation accuracy than reduction of imaging artifacts. The MARs algorithm caused a distortion in the shape of the titanium implant that substantially worsened the calculation accuracy. In comparison to water kernel dose calculations, metal kernels resulted in better modeling of the increased backscatter dose at the upstream interface but decreased accuracy directly downstream of the metal. We also found that the success of metal kernels was dependent on dose grid size, with smaller calculation voxels giving better accuracy. Conclusion: Our study yielded mixed results, with neither the metal artifact reduction methods nor the metal kernels being globally effective at improving dose calculation accuracy. However, some successes were observed. The MARs algorithm decreased errors downstream of Cerrobend by a factor of two, and metal kernels resulted in more accurate backscatter dose upstream of metals. Thus, these two strategies do have the potential to improve accuracy for patients with metal implants in certain scenarios. This work was supported by Public Health Service grants CA 180803 and CA 10953 awarded by the National Cancer Institute, United States of Health and Human Services, and in part by Mobius Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2012

Using Segmentation in CT Metal Artifact Reduction

Metal artifact reduction methods in computed tomography replace the projection data passing through metals with an estimate of the true data. Inaccurate estimation leads to the generation of secondary artifacts. Data estimates can be improved by the use of prior knowledge of the projection data. In this paper, a method has been created to generate a prior image. The method uses computer vision techniques to segment regions of the initially reconstructed image and then discriminates between regions that are likely to be artifacts and anatomical structures. Results on test images show that metal artifacts are reduced and that few secondary artifacts are present, even in the case of multiple metal objects.

42 ENGINEERING↗
DOE OSTI2014

Metallic artifact mitigation and organ-constrained tissue assignment for Monte Carlo calculations of permanent implant lung brachytherapy

Purpose: To investigate methods of generating accurate patient-specific computational phantoms for the Monte Carlo calculation of lung brachytherapy patient dose distributions. Methods: Four metallic artifact mitigation methods are applied to six lung brachytherapy patient computed tomography (CT) images: simple threshold replacement (STR) identifies high CT values in the vicinity of the seeds and replaces them with estimated true values; fan beam virtual sinogram replaces artifact-affected values in a virtual sinogram and performs a filtered back-projection to generate a corrected image; 3D median filter replaces voxel values that differ from the median value in a region of interest surrounding the voxel and then applies a second filter to reduce noise; and a combination of fan beam virtual sinogram and STR. Computational phantoms are generated from artifact-corrected and uncorrected images using several tissue assignment schemes: both lung-contour constrained and unconstrained global schemes are considered. Voxel mass densities are assigned based on voxel CT number or using the nominal tissue mass densities. Dose distributions are calculated using the EGSnrc user-code BrachyDose for{sup 125}I, {sup 103}Pd, and {sup 131}Cs seeds and are compared directly as well as through dose volume histograms and dose metrics for target volumes surrounding surgical sutures. Results: Metallic artifact mitigation techniques vary in ability to reduce artifacts while preserving tissue detail. Notably, images corrected with the fan beam virtual sinogram have reduced artifacts but residual artifacts near sources remain requiring additional use of STR; the 3D median filter removes artifacts but simultaneously removes detail in lung and bone. Doses vary considerably between computational phantoms with the largest differences arising from artifact-affected voxels assigned to bone in the vicinity of the seeds. Consequently, when metallic artifact reduction and constrained tissue assignment within lung contours are employed in generated phantoms, this erroneous assignment is reduced, generally resulting in higher doses. Lung-constrained tissue assignment also results in increased doses in regions of interest due to a reduction in the erroneous assignment of adipose to voxels within lung contours. Differences in dose metrics calculated for different computational phantoms are sensitive to radionuclide photon spectra with the largest differences for{sup 103}Pd seeds and smallest but still considerable differences for {sup 131}Cs seeds. Conclusions: Despite producing differences in CT images, dose metrics calculated using the STR, fan beam + STR, and 3D median filter techniques produce similar dose metrics. Results suggest that the accuracy of dose distributions for permanent implant lung brachytherapy is improved by applying lung-constrained tissue assignment schemes to metallic artifact corrected images.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

Metal artifact reduction in x-ray computed tomography (CT) by constrained optimization

Purpose: The streak artifacts caused by metal implants have long been recognized as a problem that limits various applications of CT imaging. In this work, the authors propose an iterative metal artifact reduction algorithm based on constrained optimization. Methods: After the shape and location of metal objects in the image domain is determined automatically by the binary metal identification algorithm and the segmentation of ''metal shadows'' in projection domain is done, constrained optimization is used for image reconstruction. It minimizes a predefined function that reflects a priori knowledge of the image, subject to the constraint that the estimated projection data are within a specified tolerance of the available metal-shadow-excluded projection data, with image non-negativity enforced. The minimization problem is solved through the alternation of projection-onto-convex-sets and the steepest gradient descent of the objective function. The constrained optimization algorithm is evaluated with a penalized smoothness objective. Results: The study shows that the proposed method is capable of significantly reducing metal artifacts, suppressing noise, and improving soft-tissue visibility. It outperforms the FBP-type methods and ART and EM methods and yields artifacts-free images. Conclusions: Constrained optimization is an effective way to deal with CT reconstruction with embedded metal objects. Although the method is presented in the context of metal artifacts, it is applicable to general ''missing data'' image reconstruction problems.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

SU-F-J-74: High Z Geometric Integrity and Beam Hardening Artifact Assessment Using a Retrospective Metal Artifact Reduction (MAR) Reconstruction Algorithm

Purpose: To test the efficacy of a retrospective metal artifact reduction (MAR) reconstruction algorithm for a commercial computed tomography (CT) scanner for radiation therapy purposes. Methods: High Z geometric integrity and artifact reduction analysis was performed with three phantoms using General Electric’s (GE) Discovery CT. The three phantoms included: a Computerized Imaging Reference Systems (CIRS) electron density phantom (Model 062) with a 6.5 mm diameter titanium rod insert, a custom spine phantom using Synthes Spine hardware submerged in water, and a dental phantom with various high Z fillings submerged in water. Each phantom was reconstructed using MAR and compared against the original scan. Furthermore, each scenario was tested using standard and extended Hounsfield Unit (HU) ranges. High Z geometric integrity was performed using the CIRS phantom, while the artifact reduction was performed using all three phantoms. Results: Geometric integrity of the 6.5 mm diameter rod was slightly overestimated for non-MAR scans for both standard and extended HU. With MAR reconstruction, the rod was underestimated for both standard and extended HU. For artifact reduction, the mean and standard deviation was compared in a volume of interest (VOI) in the surrounding material (water and water equivalent material, ∼0HU). Overall, the mean value of the VOI was closer to 0 HU for the MAR reconstruction compared to the non-MAR scan for most phantoms. Additionally, the standard deviations for all phantoms were greatly reduced using MAR reconstruction. Conclusion: GE’s MAR reconstruction algorithm improves image quality with the presence of high Z material with minimal degradation of its geometric integrity. High Z delineation can be carried out with proper contouring techniques. The effects of beam hardening artifacts are greatly reduced with MAR reconstruction. Tissue corrections due to these artifacts can be eliminated for simple high Z geometries and greatly reduced for more complex geometries.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-I-38: Improved Metal Artifact Correction Using Adaptive Dual Energy Calibration

Purpose: The empirical dual energy calibration (EDEC) method corrects for beam-hardening artifacts, but shows limited performance on metal artifact correction. In this work, we propose an adaptive dual energy calibration (ADEC) method to correct for metal artifacts. Methods: The empirical dual energy calibration (EDEC) method corrects for beam-hardening artifacts, but shows limited performance on metal artifact correction. In this work, we propose an adaptive dual energy calibration (ADEC) method to correct for metal artifacts. Results: Highly attenuating copper rods cause severe streaking artifacts on standard CT images. EDEC improves the image quality, but cannot eliminate the streaking artifacts. Compared to EDEC, the proposed ADEC method further reduces the streaking resulting from metallic inserts and beam-hardening effects and obtains material decomposition images with significantly improved accuracy. Conclusion: We propose an adaptive dual energy calibration method to correct for metal artifacts. ADEC is evaluated with the Shepp-Logan phantom, and shows superior metal artifact correction performance. In the future, we will further evaluate the performance of the proposed method with phantom and patient data.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

TU-F-CAMPUS-J-04: Evaluation of Metal Artifact Reduction Technique for the Radiation Therapy Planning

Purpose: To evaluate the feasibility of using a metal artifact reduction technique in depleting metal artifact and its application in improving dose calculation in External Radiation Therapy Planning. Methods: CIRS electron density phantom was scanned with and without steel drill bits placed in some plug holes. Meta artifact reduction software with Metal Deletion Technique (MDT) was used to remove metal artifacts for scanned image with metal. Hounsfield units of electron density plugs from artifact free reference image and MDT processed images were compared. To test the dose calculation improvement after the MDT processed images, clinically approved head and neck plan with manual dental artifact correction was tested. Patient images were exported and processed with MDT and plan was recalculated with new MDT image without manual correction. Dose profiles near the metal artifacts were compared. Results: The MDT used in this study effectively reduced the metal artifact caused by beam hardening and scatter. The windmill around the metal drill was greatly improved with smooth rounded view. Difference of the mean HU in each density plug between reference and MDT images were less than 10 HU in most of the plugs. Dose difference between original plan and MDT images were minimal. Conclusion: Most metal artifact reduction methods were developed for diagnostic improvement purpose. Hence Hounsfield unit accuracy was not rigorously tested before. In our test, MDT effectively eliminated metal artifacts with good HU reproduciblity. However, it can introduce new mild artifacts so the MDT images should be checked with original images.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-E-02: A Feasibility Study for Application of Metal Artifact Reduction Techniques in MR-Guided Brachytherapy Gynecological Cancer with Titanium Applicators

Purpose: Utilization of Titanium Tandem and Ring (T&R) applicators in MR-guided brachytherapy has become widespread for gynecological cancer treatment. However, Titanium causes magnetic field disturbance and susceptibility artifact, which complicate image interpretation. In this study, metal artifact reduction techniques were employed to improve the image quality and reduce the metal related artifacts. Methods: Several techniques were employed to reduce the metal artifact caused by titanium T&R applicator. These techniques include Metal Artifact Reduction Sequence (MARS), View Angle Tilting (VAT) to correct in-plane distortion, and Slice Encoding for Metal Artifact Correction (SEMAC) for through-plane artifact correction. Moreover, MARS can be combined with VAT to further reduce the in-plane artifact by reapplying the selection gradients during the readout (MARS+VAT). SEMAC uses a slice selective excitation but acquires additional z-encodings in order to resolve off-resonant signal and to reduce through-plane distortions. Results: Comparison between the clinical sequences revealed that increasing the bandwidth reduces the error in measured diameter of T&R. However, the error is larger than 4mm for the best case with highest bandwidth and spatial resolution. MARS+VAT with isotropic resolution of 1mm reduced the error to 1.9mm which is the least among the examined 2D sequences. The measured diameter of tandem from SEMAC+VAT has the closest value to the actual diameter of tandem (3.2mm) and the error was reduced to less than 1mm. In addition, SEMAC+VAT significantly reduces the blooming artifact in the ring compared to clinical sequences. Conclusion: A higher bandwidth and spatial resolution sequence reduces the artifact and diameter of applicator with a slight compromise in SNR. Metal artifact reduction sequences decrease the distortion associated with titanium applicator. SEMAC+VAT sequence in combination with VAT revealed promising results for titanium imaging and can be utilized for MR-guided brachytherapy in gynecological cancer. The author is employee with Philips Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-I-92: Is Photon Starvation Preventing Metal Artifact Reduction Algorithm From Working in KVCT?

Purpose: High density/high atomic number metallic objects create shading and streaking metal artifacts in the CT image that can cause inaccurate delineation of anatomical structures or inaccurate radiation dose calculation. A modified iterative maximum-likelihood polychromatic algorithm for CT (mIMPACT) that models the energy response of detectors, photon interaction processes and beam polychromaticity has successfully reduced metal artifacts in MVCT. Our extension of mIMPACT in kVCT did not significantly reduce metal artifacts for high density metal like steel. We hypothesize that photon starvation may result in the measured data in a commercial kVCT imaging beam. Methods: We measured attenuation of a range of steel plate thicknesses, sandwiched between two 12cm thick solid water blocks, using a Phillips Big Bore CTTM scanner in scout acquisition mode with 120kVp and 200mAs. The transmitted signal (y) was normalized to the air scan signal (y{sub 0}) to get attenuation [i.e., ln(y/y{sub 0})] data for a detector. Results: Below steel plate thickness of 13.4mm, the variations in measured attenuation as a function of view number are characterized by a quantum noise and show increased attenuation with metal thickness. On or above this thickness the attenuation shows discrete levels in addition to the quantum noise. Some views have saturated attenuation value. The histograms of the measured attenuation for up to 36.7mm of steel show this trend. The detector signal is so small that the quantization levels in the analog to digital (A-to-D) converter are visible, a clear indication of photon starvation. Conclusion: Photons reaching the kVCT detector after passing through a thick metal plate are either so low in number that the signal measured has large quantum noise, or are completely absorbed inside the plate creating photon starvation. This is un-interpretable by the mIMPACT algorithm and cannot reduce metal artifacts in kVCT for certain realistic thicknesses of steel hip implants. Moti Raj Paudel is supported by the Vanier Canada Graduate Scholarship, the Endowed Graduate Scholarship in Oncology and the Dissertation Fellowship at the University of Alberta. The authors acknowledge the CIHR operating grant number MOP 53254.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2016

Observer Evaluation of a Metal Artifact Reduction Algorithm Applied to Head and Neck Cone Beam Computed Tomographic Images

Purpose and Objectives: To quantify, through an observer study, the reduction in metal artifacts on cone beam computed tomographic (CBCT) images using a projection-interpolation algorithm, on images containing metal artifacts from dental fillings and implants in patients treated for head and neck (H&N) cancer. Methods and Materials: An interpolation-substitution algorithm was applied to H&N CBCT images containing metal artifacts from dental fillings and implants. Image quality with respect to metal artifacts was evaluated subjectively and objectively. First, 6 independent radiation oncologists were asked to rank randomly sorted blinded images (before and after metal artifact reduction) using a 5-point rating scale (1 = severe artifacts; 5 = no artifacts). Second, the standard deviation of different regions of interest (ROI) within each image was calculated and compared with the mean rating scores. Results: The interpolation-substitution technique successfully reduced metal artifacts in 70% of the cases. From a total of 60 images from 15 H&N cancer patients undergoing image guided radiation therapy, the mean rating score on the uncorrected images was 2.3 ± 1.1, versus 3.3 ± 1.0 for the corrected images. The mean difference in ranking score between uncorrected and corrected images was 1.0 (95% confidence interval: 0.9-1.2, P<.05). The standard deviation of each ROI significantly decreased after artifact reduction (P<.01). Moreover, a negative correlation between the mean rating score for each image and the standard deviation of the oral cavity and bilateral cheeks was observed. Conclusion: The interpolation-substitution algorithm is efficient and effective for reducing metal artifacts caused by dental fillings and implants on CBCT images, as demonstrated by the statistically significant increase in observer image quality ranking and by the decrease in ROI standard deviation between uncorrected and corrected images.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Assessment of metal artifact reduction methods in pelvic CT

Purpose: Metal artifact reduction (MAR) produces images with improved quality potentially leading to confident and reliable clinical diagnosis and therapy planning. In this work, the authors evaluate the performance of five MAR techniques for the assessment of computed tomography images of patients with hip prostheses. Methods: Five MAR algorithms were evaluated using simulation and clinical studies. The algorithms included one-dimensional linear interpolation (LI) of the corrupted projection bins in the sinogram, two-dimensional interpolation (2D), a normalized metal artifact reduction (NMAR) technique, a metal deletion technique, and a maximum a posteriori completion (MAPC) approach. The algorithms were applied to ten simulated datasets as well as 30 clinical studies of patients with metallic hip implants. Qualitative evaluations were performed by two blinded experienced radiologists who ranked overall artifact severity and pelvic organ recognition for each algorithm by assigning scores from zero to five (zero indicating totally obscured organs with no structures identifiable and five indicating recognition with high confidence). Results: Simulation studies revealed that 2D, NMAR, and MAPC techniques performed almost equally well in all regions. LI falls behind the other approaches in terms of reducing dark streaking artifacts as well as preserving unaffected regions (p < 0.05). Visual assessment of clinical datasets revealed the superiority of NMAR and MAPC in the evaluated pelvic organs and in terms of overall image quality. Conclusions: Overall, all methods, except LI, performed equally well in artifact-free regions. Considering both clinical and simulation studies, 2D, NMAR, and MAPC seem to outperform the other techniques.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-J-73: Simple Approach for Quantification of Metal Artifact Reduction Capabalities of Dual-Energy CT

Purpose: To present a simple method for quantification of dual-energy CT metal artifact reduction capabilities Methods: A phantom was constructed from solid water and a steel cylinder. Solid water is commonly used for radiotherapy QA, while steel cylinders are readily available in hardware stores. The phantom was scanned on Siemens Somatom 64-slice dual-energy CT system. Three CTs were acquired at energies of 80kV (low), 120kV (nominal), and 140kV (high). The low and high energy acquisitions were used to generate dual-energy (DE) monoenergetic image sets, which also utilized metal artifact reduction algorithm (Maris). Several monoenergetic DE image sets, ranging from 70keV to 190keV were generated. The size of the metal artifact was measured by two different approaches. The first approach measured the distance from the center of the steel cylinder to a location with nominal (undisturbed by metal) HU value for the 120kV, DE 70keV, and DE 190keV image sets. In the second approach, the distance from the center of the cylinder to the edge of the air pocket for the above mentioned three image sets was measured. Results: The DE 190keV synthetic image set demonstrated the largest reduction of the metal artifacts. The size of the artifact was more than three times the actual size of the milled hole in the solid water in the DE 190keV, as compared to more than 7.5 times larger as estimated from the 120kV uncorrected image Conclusion: A simple phantom for quantification of dual-energy CT metal artifact reduction capabilities was presented. This inexpensive phantom can be easily built from components available in every radiation oncology department. It allows quick assessment and quantification of the properties of different metal artifact reduction algorithms, available on modern dual-energy CT scanners.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Clinical Evaluation of Normalized Metal Artifact Reduction in kVCT Using MVCT Prior Images (MVCT-NMAR) for Radiation Therapy Treatment Planning

Purpose: To evaluate the metal artifacts in diagnostic kilovoltage computed tomography (kVCT) images of patients that are corrected by use of a normalized metal artifact reduction (NMAR) method with megavoltage CT (MVCT) prior images: MVCT-NMAR. Methods and Materials: MVCT-NMAR was applied to images from 5 patients: 3 with dual hip prostheses, 1 with a single hip prosthesis, and 1 with dental fillings. The corrected images were evaluated for visualization of tissue structures and their interfaces and for radiation therapy dose calculations. They were compared against the corresponding images corrected by the commercial orthopedic metal artifact reduction algorithm in a Phillips CT scanner. Results: The use of MVCT images for correcting kVCT images in the MVCT-NMAR technique greatly reduces metal artifacts, avoids secondary artifacts, and makes patient images more useful for correct dose calculation in radiation therapy. These improvements are significant, provided the MVCT and kVCT images are correctly registered. The remaining and the secondary artifacts (soft tissue blurring, eroded bones, false bones or air pockets, CT number cupping within the metal) present in orthopedic metal artifact reduction corrected images are removed in the MVCT-NMAR corrected images. A large dose reduction was possible outside the planning target volume (eg, 59.2 Gy to 52.5 Gy in pubic bone) when these MVCT-NMAR corrected images were used in TomoTherapy treatment plans without directional blocks for a prostate cancer patient. Conclusions: The use of MVCT-NMAR corrected images in radiation therapy treatment planning could improve the treatment plan quality for patients with metallic implants.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Evaluation of normalized metal artifact reduction (NMAR) in kVCT using MVCT prior images for radiotherapy treatment planning

Purpose: To evaluate the metal artifacts in kilovoltage computed tomography (kVCT) images that are corrected using a normalized metal artifact reduction (NMAR) method with megavoltage CT (MVCT) prior images.Methods: Tissue characterization phantoms containing bilateral steel inserts are used in all experiments. Two MVCT images, one without any metal artifact corrections and the other corrected using a modified iterative maximum likelihood polychromatic algorithm for CT (IMPACT) are translated to pseudo-kVCT images. These are then used as prior images without tissue classification in an NMAR technique for correcting the experimental kVCT image. The IMPACT method in MVCT included an additional model for the pair/triplet production process and the energy dependent response of the MVCT detectors. An experimental kVCT image, without the metal inserts and reconstructed using the filtered back projection (FBP) method, is artificially patched with the known steel inserts to get a reference image. The regular NMAR image containing the steel inserts that uses tissue classified kVCT prior and the NMAR images reconstructed using MVCT priors are compared with the reference image for metal artifact reduction. The Eclipse treatment planning system is used to calculate radiotherapy dose distributions on the corrected images and on the reference image using the Anisotropic Analytical Algorithm with 6 MV parallel opposed 5 × 10 cm{sup 2} fields passing through the bilateral steel inserts, and the results are compared. Gafchromic film is used to measure the actual dose delivered in a plane perpendicular to the beams at the isocenter.Results: The streaking and shading in the NMAR image using tissue classifications are significantly reduced. However, the structures, including metal, are deformed. Some uniform regions appear to have eroded from one side. There is a large variation of attenuation values inside the metal inserts. Similar results are seen in commercially corrected image. Use of MVCT prior images without tissue classification in NMAR significantly reduces these problems. The radiation dose calculated on the reference image is close to the dose measured using the film. Compared to the reference image, the calculated dose difference in the conventional NMAR image, the corrected images using uncorrected MVCT image, and IMPACT corrected MVCT image as priors is ∼15.5%, ∼5%, and ∼2.7%, respectively, at the isocenter.Conclusions: The deformation and erosion of the structures present in regular NMAR corrected images can be largely reduced by using MVCT priors without tissue segmentation. The attenuation value of metal being incorrect, large dose differences relative to the true value can result when using the conventional NMAR image. This difference can be significantly reduced if MVCT images are used as priors. Reduced tissue deformation, better tissue visualization, and correct information about the electron density of the tissues and metals in the artifact corrected images could help delineate the structures better, as well as calculate radiation dose more correctly, thus enhancing the quality of the radiotherapy treatment planning.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

WE-G-18A-07: Clinical Evaluation of Normalized Metal Artifact Reduction in KVCT Using MVCT Prior Images (MVCT-NMAR) Technique in Radiotherapy

Purpose: To evaluate the metal artifacts in diagnostic kVCT images of patients that are corrected using a normalized metal artifact reduction method with MVCT prior images, MVCT-NMAR. Methods: An MVCTNMAR algorithm was developed and applied to five patients: three with bilateral hip prostheses, one with unilateral hip prosthesis and one with dental fillings. The corrected images were evaluated for visualization of tissue structures and their interfaces, and for radiotherapy dose calculations. They were also compared against the corresponding images corrected by a commercial metal artifact reduction technique, O-MAR, on a Phillips™ CT scanner. Results: The use of MVCT images for correcting kVCT images in the MVCT-NMAR technique greatly reduces metal artifacts, avoids secondary artifacts, and makes patient images more useful for correct dose calculation in radiotherapy. These improvements are significant over the commercial correction method, provided the MVCT and kVCT images are correctly registered. The remaining and the secondary artifacts (soft tissue blurring, eroded bones, false bones or air pockets, CT number cupping within the metal) present in O-MAR corrected images are removed in the MVCT-NMAR corrected images. Large dose reduction is possible outside the planning target volume (e.g., 59.2 Gy in comparison to 52.5 Gy in pubic bone) when these MVCT-NMAR corrected images are used in TomoTherapy™ treatment plans, as the corrected images no longer require directional blocks for prostate plans in order to avoid the image artifact regions. Conclusion: The use of MVCT-NMAR corrected images in radiotherapy treatment planning could improve the treatment plan quality for cancer patients with metallic implants. Moti Raj Paudel is supported by the Vanier Canada Graduate Scholarship, the Endowed Graduate Scholarship in Oncology and the Dissertation Fellowship at the University of Alberta. The authors acknowledge the CIHR operating grant number MOP 53254.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Moving metal artifact reduction in cone-beam CT scans with implanted cylindrical gold markers

Purpose: Implanted gold markers for image-guided radiotherapy lead to streaking artifacts in cone-beam CT (CBCT) scans. Several methods for metal artifact reduction (MAR) have been published, but they all fail in scans with large motion. Here the authors propose and investigate a method for automatic moving metal artifact reduction (MMAR) in CBCT scans with cylindrical gold markers. Methods: The MMAR CBCT reconstruction method has six steps. (1) Automatic segmentation of the cylindrical markers in the CBCT projections. (2) Removal of each marker in the projections by replacing the pixels within a masked area with interpolated values. (3) Reconstruction of a marker-free CBCT volume from the manipulated CBCT projections. (4) Reconstruction of a standard CBCT volume with metal artifacts from the original CBCT projections. (5) Estimation of the three-dimensional (3D) trajectory during CBCT acquisition for each marker based on the segmentation in Step 1, and identification of the smallest ellipsoidal volume that encompasses 95% of the visited 3D positions. (6) Generation of the final MMAR CBCT reconstruction from the marker-free CBCT volume of Step 3 by replacing the voxels in the 95% ellipsoid with the corresponding voxels of the standard CBCT volume of Step 4. The MMAR reconstruction was performed retrospectively using a half-fan CBCT scan for 29 consecutive stereotactic body radiation therapy patients with 2–3 gold markers implanted in the liver. The metal artifacts of the MMAR reconstructions were scored and compared with a standard MAR reconstruction by counting the streaks and by calculating the standard deviation of the Hounsfield units in a region around each marker. Results: The markers were found with the same autosegmentation settings in 27 CBCT scans, while two scans needed slightly changed settings to find all markers automatically in Step 1 of the MMAR method. MMAR resulted in 15 scans with no streaking artifacts, 11 scans with 1–4 streaks, and 3 scans with severe streaking artifacts. The corresponding numbers for MAR were 8 (no streaks), 1 (1–4 streaks), and 20 (severe streaking artifacts). The MMAR method was superior to MAR in scans with more than 8 mm 3D marker motion and comparable to MAR for scans with less than 8 mm motion. In addition, the MMAR method was tested on a 4D CBCT reconstruction for which it worked equally well as for the 3D case. The markers in the 4D case had very low motion blur. Conclusions: An automatic method for MMAR in CBCT scans was proposed and shown to effectively remove almost all streaking artifacts in a large set of clinical CBCT scans with implanted gold markers in the liver. Residual streaking artifacts observed in three CBCT scans may be removed with better marker segmentation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Dual energy CT: How well can pseudo-monochromatic imaging reduce metal artifacts?

Purpose: Dual Energy CT (DECT) provides so-called monoenergetic images based on a linear combination of the original polychromatic images. At certain patient-specific energy levels, corresponding to certain patient- and slice-dependent linear combination weights, e.g., E = 160 keV corresponds to α = 1.57, a significant reduction of metal artifacts may be observed. The authors aimed at analyzing the method for its artifact reduction capabilities to identify its limitations. The results are compared with raw data-based processing. Methods: Clinical DECT uses a simplified version of monochromatic imaging by linearly combining the low and the high kV images and by assigning an energy to that linear combination. Those pseudo-monochromatic images can be used by radiologists to obtain images with reduced metal artifacts. The authors analyzed the underlying physics and carried out a series expansion of the polychromatic attenuation equations. The resulting nonlinear terms are responsible for the artifacts, but they are not linearly related between the low and the high kV scan: A linear combination of both images cannot eliminate the nonlinearities, it can only reduce their impact. Scattered radiation yields additional noncanceling nonlinearities. This method is compared to raw data-based artifact correction methods. To quantify the artifact reduction potential of pseudo-monochromatic images, they simulated the FORBILD abdomen phantom with metal implants, and they assessed patient data sets of a clinical dual source CT system (100, 140 kV Sn) containing artifacts induced by a highly concentrated contrast agent bolus and by metal. In each case, they manually selected an optimal α and compared it to a raw data-based material decomposition in case of simulation, to raw data-based material decomposition of inconsistent rays in case of the patient data set containing contrast agent, and to the frequency split normalized metal artifact reduction in case of the metal implant. For each case, the contrast-to-noise ratio (CNR) was assessed. Results: In the simulation, the pseudo-monochromatic images yielded acceptable artifact reduction results. However, the CNR in the artifact-reduced images was more than 60% lower than in the original polychromatic images. In contrast, the raw data-based material decomposition did not significantly reduce the CNR in the virtual monochromatic images. Regarding the patient data with beam hardening artifacts and with metal artifacts from small implants the pseudo-monochromatic method was able to reduce the artifacts, again with the downside of a significant CNR reduction. More intense metal artifacts, e.g., as those caused by an artificial hip joint, could not be suppressed. Conclusions: Pseudo-monochromatic imaging is able to reduce beam hardening, scatter, and metal artifacts in some cases but it cannot remove them. In all cases, the CNR is significantly reduced, thereby rendering the method questionable, unless special post processing algorithms are implemented to restore the high CNR from the original images (e.g., by using a frequency split technique). Raw data-based dual energy decomposition methods should be preferred, in particular, because the CNR penalty is almost negligible.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-I-75: Evaluation of An Orthopedic Metal Artifact Reduction (O-MAR) Algorithm On Patients with Spinal Prostheses Near Spinal Tumors

Purpose: To evaluate the impact of a commercial orthopedic metal artifact reduction (O-MAR) algorithm on CT image quality and dose calculation for patients with spinal prostheses near spinal tumors. Methods: A CT electron density phantom was scanned twice: with tissue-simulating inserts only, and with a titanium insert replacing solid water. A patient plan was mapped to the phantom images in two ways: with the titanium inside or outside of the spinal tumor. Pinnacle and Eclipse were used to evaluate the dosimetric effects of O-MAR on 12-bit and 16-bit CT data, respectively. CT images from five patients with spinal prostheses were reconstructed with and without O-MAR. Two observers assessed the image quality improvement from O-MAR. Both pencil beam and Monte Carlo dose calculation in iPlan were used for the patient study. The percentage differences between non-OMAR and O-MAR datasets were calculated for PTV-min, PTV-max, PTV-mean, PTV-V100, PTV-D90, OAR-V10Gy, OAR-max, and OAR-D0.1cc. Results: O-MAR improved image quality but did not significantly affect the dose distributions and DVHs for both 12-bit and 16- bit CT phantom data. All five patient cases demonstrated some degree of image quality improvement from O-MAR, ranging from small to large metal artifact reduction. For pencil beam, the largest discrepancy was observed for OARV-10Gy at 5.4%, while the other seven parameters were ≤0.6%. For Monte Carlo, the differences between non-O-MAR and O-MAR datasets were ≤3.0%. Conclusion: Both phantom and patient studies indicated that O-MAR can substantially reduce metal artifacts on CT images, allowing better visualization of the anatomical structures and metal objects. The dosimetric impact of O-MAR was insignificant regardless of the metal location, image bit-depth, and dose calculation algorithm. O-MAR corrected images are recommended for radiation treatment planning on patients with spinal prostheses because of the improved image quality and no need to modify current dose constraints. This work was supported by a research grant from Philips Healthcare. Paul Klahr is an employee of Philips Healthcare.

60 APPLIED LIFE SCIENCES↗