The CT number accuracy of a novel commercial metal artifact reduction algorithm for large orthopedic implants

Philips Healthcare released a novel metal artifact reduction algorithm for large orthopedic implants (O-MAR). Little information was available about its CT number accuracy. Since CT numbers are used for tissue heterogeneity corrections in external beam radiotherapy treatment planning, we performed a phantom study to assess the CT number accuracy of O-MAR. Two situations were simulated: a patient with a unilateral metallic hip prosthesis and a patient with bilateral metallic hip prostheses. We compared the CT numbers in the O-MAR reconstructions of the simulations to those in the nonO-MAR reconstruction and to those in a metal-free baseline reconstruction. In both simulations, the CT number accuracy of the O-MAR reconstruction was better than the CT number accuracy of the nonO- MAR reconstruction. In the O-MAR reconstruction of the unilateral simulation, all CT numbers were accurate within ± 5 HU (AAPM criterion). In the O-MAR reconstruction of the bilateral simulation, CT numbers were found that differed more than ± 5 HU from the metal-free baseline values. However, none of these differences were clinically relevant.