title: The effects of metal artifact reduction on the retrieval of attenuation values.
abstract: BACKGROUND
  The quality of CT slices can be drastically reduced in the presence of high-density objects such as metal implants within the patients' body due to the occurrence of streaking artifacts. Consequently, a delineation of anatomical structures might not be possible, which strongly influences clinical examination.
  
  
  OBJECTIVE
  The aim of the study is to clinically evaluate the retrieval of attenuation values and structures by the recently proposed Augmented Likelihood Image Reconstruction (ALIR) and linear interpolation in the presence of metal artifacts.
  
  
  METHODS
  A commercially available phantom was equipped with two steel inserts. At a position between the metal rods, which shows severe streaking artifacts, different human tissue-equivalent inserts are alternately mounted. Using a single-source computer tomograph, raw data with and without metal rods are acquired for each insert. Images are reconstructed using the ALIR algorithm and a filtered back projection with and without linear interpolation. Mean and standard deviation are compared for a region of interest in the ALIR reconstructions, linear interpolation results, uncorrected images with metal rods, and the images without metal rods, which are used as a reference. Furthermore, the reconstructed shape of the inserts is analyzed by comparing different profiles of the image.
  
  
  RESULTS
  The measured mean and standard deviation values show that for all tissue classes, the metal artifacts could be reduced using the ALIR algorithm and the linear interpolation. Furthermore, the HU values for the different classes could be retrieved with errors below the standard deviation in the reference image. An evaluation of the shape of the inserts shows that the reconstructed object fits the shape of the insert accurately after metal artifact correction. Moreover, the evaluation shows a drop in the standard deviation for the ALIR reconstructed images compared to the reference images while reducing artifacts and keeping the shape of the inserts, which indicates a noise reduction ability of the ALIR algorithm.
  
  
  CONCLUSIONS
  HU values, which are distorted by metal artifacts, can be retrieved accurately with the ALIR algorithm and the linear interpolation approach. After metal artifact correction, structures, which are not perceptible in the original images due to streaking artifacts, are reconstructed correctly within the image using the ALIR algorithm. Furthermore, the ALIR produced images with a reduced noise level compared to reference images and artifact images. Linear interpolation results in a distortion of the investigated shapes and features remaining streaking artifacts.
authors.affiliation: University Hospital Schleswig Holstein, Department of Radiotherapy / Campus Luebeck Department of Radiotherapy, Ratzeburger Allee 160, D-23562, Luebeck, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ziemann
authors.affiliation: University of Luebeck, Institute of Medical Engineering, Ratzeburger Allee 160, D-23562, Luebeck, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Stille
authors.affiliation: University Hospital Schleswig Holstein, Department of Radiotherapy / Campus Luebeck Department of Radiotherapy, Ratzeburger Allee 160, D-23562, Luebeck, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Cremers
authors.affiliation: University Hospital Schleswig Holstein, Department of Radiotherapy / Campus Luebeck Department of Radiotherapy, Ratzeburger Allee 160, D-23562, Luebeck, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: University of Luebeck, Institute of Medical Engineering, Ratzeburger Allee 160, D-23562, Luebeck, Germany.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Buzug
mesh_terms: D000465:Algorithms; D016477:Artifacts; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008670:Metals; D019047:Phantoms, Imaging; D019736:Prostheses and Implants; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated; D012815:Signal Processing, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D008670:Metals
keywords: hounsfield units; implants; metal artifact reduction; prosthesis; radiotherapy