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Structure delineation in the presence of metal - A comparative phantom study using single and dual-energy computed tomography with and without metal artefact reduction

Journal article
Authors Erik Pettersson
Anna Bäck
Thomas Björk-Eriksson
Ulrika Lindencrona
Karin Petruson
Anne Thilander-Klang
Published in Physics and Imaging in Radiation Oncology
Volume 9
Pages 43-49
Publication year 2019
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Oncology
Pages 43-49
Language en
Links https://doi.org/10.1016/j.phro.2019...
Keywords Radiotherapy Treatment planning Computed tomography Delineation uncertainty Dual-energy computed tomography Metal artefact reduction
Subject categories Cancer and Oncology, Radiology, Diagnostic radiology, Radiological physics

Abstract

Background and purpose: Metal artefacts in computed tomography (CT) images impairs structure delineation. These artefacts can potentially be reduced with dual-energy CT (DECT) with or without using metal artefact reduction (MAR). The purpose was to investigate how structure delineation in DECT with or without MAR and single-energy CT (SECT) images were affected by metals. Materials and methods: A phantom with known irregular structures was developed. References tructures were determined from a low-noise scan without metal. Bilateral hip prostheses were simulated with steel or titanium inserts. The phantom was scanned with SECT and fast-kV switching DECT with optional MAR. Four radiation oncologists delineated the structures in two phantom set-ups. Delineated structures were evaluated with Dice similarity coefficient (DSC) and Hausdorff distance relative to the reference structures. Results: With titanium inserts, more structures were detected for non-MAR DECT compared to SECT while the same or less were detected with steel inserts. MAR improved delineation in DECT images. For steel inserts, Three structures in the region of artefacts, were delineated by at least two oncologists with MAR-DECT compared to none with non-MAR DECT or SECT. The highest values of DSC for MAR-DECT were 0.69, 0.81 and 0.77 for those structures. Conclusions: Delineation was improved with non-MAR DECT compared to SECT, especially for titanium inserts. A larger improvement was seen with the use of MAR for both steel and titanium inserts. The improvement was dependent on the location of the structure relative to the inserts, and the structure contrast relative to the background.

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