An interactive task-based method for the avoidance of metal artifacts in CBCT

Purpose Intraoperative cone-beam CT imaging enables 3D validation of implant positioning and fracture reduction for orthopedic and trauma surgeries. However, the emergence of metal artifacts, especially in the vicinity of metallic objects, severely degrades the clinical value of the imaging modality. In previous works, metal artifact avoidance (MAA) methods have been shown to reduce metal artifacts by adapting the scanning trajectory. Yet, these methods fail to translate to clinical practice due to remaining methodological constraints and missing workflow integration. Methods In this work, we propose a method to compute the spatial distribution and calibrated strengths of expected artifacts for a given tilted circular trajectory. By visualizing this as an overlay changing with the C-Arm’s tilt, we enable the clinician to interactively choose an optimal trajectory while factoring in the procedural context and clinical task. We then evaluate this method in a realistic human cadaver study and compare the achieved image quality to acquisitions optimized using global metrics. Results We assess the effectiveness of the compared methods by evaluation of image quality gradings of depicted pedicle screws. We find that both global metrics as well as the proposed visualization of artifact distribution enable a drastic improvement compared to standard non-tilted scans. Furthermore, the novel interactive visualization yields a significant improvement in subjective image quality compared to the state-of-the-art global metrics. Additionally we show that by formulating an imaging task, the proposed method allows to selectively optimize image quality and avoid artifacts in the region of interest. Conclusion We propose a method to spatially resolve predicted artifacts and provide a calibrated measure for artifact strength grading. This interactive MAA method proved practical and effective in reducing metal artifacts in the conducted cadaver study. We believe this study serves as a crucial step toward clinical application of an MAA system to improve image quality and enhance the clinical validation of implant placement.