Dose Reduction With Dedicated CT Metal Artifact Reduction Algorithm: CT Phantom Study.

Objective: The objective of this study was to compare reader accuracy detecting lesions near hardware in a CT phantom model at different radiation exposures using an advanced metal artifact reduction (MAR) algorithm and standard filtered back projection (FBP) techniques and to determine if radiation exposure could be decreased using MAR without compromising lesion detectability.
Materials and Methods: A CT phantom manufactured with spherical lesions of various sizes (10-20 mm) and attenuations (20-50 HU) embedded around cobalt-chromium spheres attached to titanium rods, simulating an arthroplasty, was scanned on a single CT scanner (FLASH, Siemens Healthcare) at 140 kVp and 0.6-mm collimation using clinical-dose (300 Quality Reference mAs [Siemens Healthcare]), low-dose (150 Quality Reference mAs), and high-dose (600 Quality Reference mAs) protocols. Images reconstructed with iterative MAR, advanced modeled iterative reconstruction (ADMIRE), and FBP with identical parameters were anonymized and independently reviewed by three radiologists. Accuracies for detecting lesions, measured as AUC, sensitivity, and specificity, were compared.
Results: Accuracy using MAR was significantly higher than that using FBP at all exposures (p values ranged from < 0.001 to 0.021). Sensitivity was also higher for MAR than for FBP at all exposures. Specificity was very high for both reconstruction techniques at all exposures with no significant differences. Accuracy of low-dose MAR was higher than and not inferior to standard-dose and high-dose FBP. MAR was significantly more sensitive than FBP in detecting smaller lesions (p = 0.021) and lesions near high streak artifact (p < 0.001).
Conclusion: MAR improves reader accuracy to detect lesions near hardware and allows significant reductions in radiation exposure without compromising accuracy compared with FBP in a CT phantom model.