Metal Artifact Reduction with DECT
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1 Metal Artifact Reduction with DECT Daniele Marin, MD Duke University Medical Center
2 Metal artifacts Common clinical problem ( 20%) Boas EF et al. Radiology 2011
3 Beam Hardening Edge Effects Scatter Metal artifacts Photon starvation Motion
4 Factors influencing artifact: 1. Density: Metal artifacts Cobalt chrome +++ Stainless steel ++ Titanium + 1. Shape: Complex +++ Simple + 2. Orientation: In plane long axis +++ In plane short axis ++ Out of plane + 1. Motion
5 Metal artifacts Correction Strategy kvp and/or filtration Spatial resolution Temporal resolution When? Mechanism Side Effects Acquisition beam hardening photon starvation dose contrast Acquisition partial volume noise Acquisition motion dose (gating) Dual energy CT (VMI) Acquisition beam hardening contrast Correction algorithms Reconstruction beam hardening noise
6 signal z-axis spatial resolution FWHM SSP z-axis (mm) Pitch Section Thickness DOSE NOISE
7 3 mm stent Gemstone technology High Definition imaging Smaller detector elements in x/y 0.23 mm spatial resolution across entire body 18 lp/cm spatial resolution for cardiac Reduced aliasing artifacts 128 slice reconstruction Focal spot motion (x-y deflection) < 20cm from isocenter (984 views) (2460 views) Non-HDCT HD 7
8 Improving resolution - blooming reduction in the stent Std. resolution High resolution Images courtesy of Dr Sablayrolles, CCN 8
9 CARDIAC CT Improved spatial resolution lp/cm 1 Reduced calcium blooming Improved stent visualization Improved diagnostic confidence Standard resolution High resolution Standard resolution High resolution 1. Based upon internal test data comparing Revolution HD cardiac half-scan spatial resolution to data from Advanced CT Scanners for Coronary Angiography, ImPACT Report CEP10043, March, 2010, available at 9
10 Motion correction No gating Cardiac gating
11 REVOLUTION GSI SnapShot * Freeze decreases calcium blooming Std. Cardiac Cardiac w/ SSF * Trademark of General Electric Company
12 Dual Energy CT (VMI)
13 Dual Energy CT (VMI) Guggenberger et al. Eur Rad 2012
14 Data Processing Monoenergetic 64 kev 69 kev 89 kev 105 kev 190 kev Courtesy of Thorsten Johnson (University Hospital Großhadern, Germany) Restricted Siemens AG 2013 All rights reserved. Page Matthew Fuld / CT Research Collaborations
15 Metal Artifact Reduction 140Sn kvp 190 kev 190 kev image shows less blooming caused by metal due to reduced beam hardening in the monoenergetic images. Page 15 Courtesy of, MGH, Boston, MA Siemens All rights reserved.
16 Data Processing Monoenergetic 64 kev 69 kev 89 kev 105 kev 190 kev Courtesy of Thorsten Johnson (University Hospital Großhadern, Germany) Restricted Siemens AG 2013 All rights reserved. Page Matthew Fuld / CT Research Collaborations
17 GSI allows for virtually artifact free visualization of the COW Better definition of the COW Dose neutral compared to SECT with 60% ASiR mgy-cm DLP 1.4 msv 1 effective dose SECT: 120 kvp VMI at 140 kev Images courtesy of MD Marcus C., University Hospital of Reims, France 1. Obtained by EUR EN, using an adult head factor of *DLP 17
18 CARDIAC CT Case showing lumen visualization with monochromatic imaging SECT: 120 kvp VMI at 140 kev. *Trademark of General Electric Company Images courtesy of Dr. J Earls, Fairfax Radiology, Virginia 18
19 Limitations VMI...? o No correction for scatter and photon starvation o Idealized x-ray absorption spectrum (no k-edge) o High kev yielding iodine/soft tissue contrast o Suboptimal arterial enhancement
20 90 kev 55 kev
21 Correction algorithms 1 st step Uncorrected reconstruction (only BH from soft tissues is accounted for ) 2 nd step Identification process (metal/bone identified from raw data applying HU threshold ) 3 rd step Correction process 1. Custom BH correction 2. Inpainting techniques to to correct for photon starvation 4 th step Corrected image Boas EF et al. Radiology 2011
22 Neurocoil WFBP imar
23 Shoulders WFBP imar
24 Hip Implants WFBP imar
25 REVOLUTION GSI GSI MAR - metal artifact reduction in arthrodesis Metal artifact reduction arthrodesis GSI at 140 kev w/ MARS Conventional CT axial images GSI at 140 kev w/ MARS Images courtesy of OUH Svendborg, Denmark
26 Metal artifact reduction, splenic aneurysm embolization Standard 120 kv acquisition GSI at 140 kev w/ MARS Metal artifact reduction with GSI enabled better visualization of splenic aneurysm embolization vs. conventional CT Images courtesy of Dr. JL Sablayrolles, CCN, France 26
27 Limitations of metal artifact correction algorithms o Location of object (central vs. peripheral) o Orientation of object (transverse vs. oblique) o Motion o Proximity to other high density objects Brook et al. Radiology 2012
28 MARS & artifacts dark star far-field artifact Brook et al. Radiology 2012
29 Conclusions o Metal artifacts is a complex phenomenon o Different strategies for artifact correction have different pros & cons o DECT with VMI is a powerful tool for metal artifacts reduction o Workflow optimization is necessary o Correction algorithms can correct for both beam hardening and photon starvation effects
30 Thank You!
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