WE-D-18A-01: Evaluation of Three Commercial Metal Artifact Reduction Methods for CT Simulations in Radiation Therapy Treatment Planning




To evaluate three commercial metal artifact reduction methods (MAR) in the context of radiation therapy treatment planning.


Three MAR strategies were evaluated: Philips O-MAR, monochromatic imaging using Gemstone Spectral Imaging (GSI) dual energy CT, and monochromatic imaging with metal artifact reduction software (GSIMARs). The Gammex RMI 467 tissue characterization phantom with several metal rods and two anthropomorphic phantoms (pelvic phantom with hip prosthesis and head phantom with dental fillings), were scanned with and without (baseline) metals. Each MAR method was evaluated based on CT number accuracy, metal size accuracy, and reduction in the severity of streak artifacts. CT number difference maps between the baseline and metal scan images were calculated, and the severity of streak artifacts was quantified using the percentage of pixels with >40 HU error (“bad pixels”).


Philips O-MAR generally reduced HU errors in the RMI phantom. However, increased errors and induced artifacts were observed for lung materials. GSI monochromatic 70keV images generally showed similar HU errors as 120kVp imaging, while 140keV images reduced errors. GSI-MARs systematically reduced errors compared to GSI monochromatic imaging. All imaging techniques preserved the diameter of a stainless steel rod to within ±1.6mm (2 pixels). For the hip prosthesis, O-MAR reduced the average % bad pixels from 47% to 32%. For GSI 140keV imaging, the percent of bad pixels was reduced from 37% to 29% compared to 120kVp imaging, while GSI-MARs further reduced it to 12%. For the head phantom, none of the MAR methods were particularly successful.


The three MAR methods all improve CT images for treatment planning to some degree, but none of them are globally effective for all conditions. The MAR methods were successful for large metal implants in a homogeneous environment (hip prosthesis) but were not successful for the more complicated case of dental artifacts.