Low-dose CT with metal artifact reduction in arthroplasty imaging: a cadaveric and clinical study
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SCIENTIFIC ARTICLE
Low-dose CT with metal artifact reduction in arthroplasty imaging: a cadaveric and clinical study Naveen Subhas 1 & Bong J. Jun 2 & Parthiv N. Mehta 1 & Eric T. Ricchetti 3 & Nancy A. Obuchowski 4 & Andrew N. Primak 5 & Joseph P. Iannotti 3 Received: 27 May 2020 / Revised: 15 September 2020 / Accepted: 5 October 2020 # ISS 2020
Abstract Objective To determine whether a simulated low-dose metal artifact reduction (MAR) CT technique is comparable with a clinical dose MAR technique for shoulder arthroplasty evaluation. Materials and methods Two shoulder arthroplasties in cadavers and 25 shoulder arthroplasties in patients were scanned using a clinical dose (140 kVp, 300 qrmAs); cadavers were also scanned at half dose (140 kVp, 150 qrmAs). Images were reconstructed using a MAR CT algorithm at full dose and a noise-insertion algorithm simulating 50% dose reduction. For the actual and simulated half-dose cadaver scans, differences in SD for regions of interest were assessed, and streak artifact near the arthroplasty was graded by 3 blinded readers. Simulated half-dose scans were compared with full-dose scans in patients by measuring differences in implant position and by comparing readers’ grades of periprosthetic osteolysis and muscle atrophy. Results The mean difference in SD between actual and simulated half-dose methods was 2.42 HU (95% CI [1.4, 3.4]). No differences in streak artifact grades were seen in 13/18 (72.2%) comparisons in cadavers. In patients, differences in implant position measurements were within 1° or 1 mm in 149/150 (99.3%) measurements. The inter-reader agreement rates were nearly identical when readers were using full-dose (77.3% [232/300] for osteolysis and 76.9% [173/225] for muscle atrophy) and simulated half-dose (76.7% [920/1200] for osteolysis and 74.0% [666/900] for muscle atrophy) scans. Conclusion A simulated half-dose MAR CT technique is comparable both quantitatively and qualitatively with a standard-dose technique for shoulder arthroplasty evaluation, demonstrating that this technique could be used to reduce dose in arthroplasty imaging. Keywords Metal artifact reduction . Shoulder . Arthroplasty . Low dose . CT technique
Introduction Computed tomography (CT) is routinely used in patients with metallic implants to diagnose complications such as hardware
* Naveen Subhas [email protected] 1
Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
2
Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
3
Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
4
Department of Biostatistics, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
5
Siemens Medical Solutions USA, Inc., Malvern, PA 19355, USA
malpositioning, failure, or infection. Imaging metal implants with CT, however, results in significant artifact, primarily due to photon starvation and beam hardening [1, 2]. Traditional CT metal artifact reduction (MAR) techniques e
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