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The present study aimed to develop a denoising convolutional neural network metal artifact reduction hybrid reconstruction (DnCNN-MARHR) algorithm for decreasing metal objects in digital tomosynthesis (DT) for arthroplasty by using projection data. For metal artifact reduction (MAR), we implemented a DnCNN-MARHR algorithm based on a training network (mini-batch stochastic gradient descent algorithm with momentum) to estimate the residual reference (140 keV virtual monochromatic [VM]) and object (70 kV with metal artifacts) images. For this, we used projection data and subtracted the estimated residual images from the object images, involving hybrid and subjectively reconstructed image usage (back projection and maximum likelihood expectation maximization [MLEM]). The DnCNN-MARHR algorithm was compared with the dual-energy material decomposition reconstruction algorithm (DEMDRA), VM, MLEM, established and commonly used filtered back projection (FBP), and a simultaneous algebraic reconstruction technique-total variation (SART-TV) with MAR processing. MAR was compared using artifact index (AI) and texture analysis. Artifact spread functions (ASFs) for images that were out-of-plane and in-focus were evaluated using a prosthesis phantom. The overall performance of the DnCNN-MARHR algorithm was adequate with regard to the ASF, and the derived images showed better results, without being influenced by the metal type (AI was almost equal to the best value for the DEMDRA). In the ASF analysis, the DnCNN-MARHR algorithm generated better MAR compared with that obtained employing usual algorithms for reconstruction using MAR processing. In addition, comparison of the difference (mean square error) between DnCNN-MARHR and the conventional algorithm resulted in the smallest VM. The DnCNN-MARHR algorithm showed the best performance with regard to image homogeneity in the texture analysis. The proposed algorithm is particularly useful for reducing artifacts in the longitudinal direction, and it is not affected by tissue misclassification., Competing Interests: The authors have declared that no competing interests exist.

In this study, a novel dual-energy (DE) material decomposition reconstruction algorithm (DEMDRA) was developed using projection data with the aim of reducing metal artifacts during digital tomosynthesis (DT) for implants. Using the three-material decomposition method and decomposition projection data specific for each material, a novel DEMDRA was implemented to reduce metal artifacts via weighted hybrid reconstructed images [maximum likelihood expectation maximization (MLEM) and shift-and-add (SAA)]. Pulsed X-ray exposures with rapid switching between low and high tube potential kVp were used for DE-DT imaging, and the images were compared using conventional filtered back projection (FBP), MLEM, the simultaneous algebraic reconstruction technique total variation (SART-TV), virtual monochromatic processing, and metal artifact reduction (MAR)-processing algorithms. The reductions in metal artifacts were compared using an artifact index (AI), Gumbel distribution of the largest variations, and the artifact spread functions (ASFs) for prosthesis phantom. The novel DEMDRA yielded an adequately effective overall performance in terms of the AI, and the resulting images yielded good results independently of the type of metal used in the prosthetic phantom, as well as good noise artifact removal, particularly at greater distances from metal objects. Furthermore, the DEMDRA represented the minimum in the model of largest variations. Regarding the ASF analysis, the novel DEMDRA yielded superior metal artifact reduction when compared with conventional reconstruction algorithms with and without MAR processing. Finally, the DEMDRA was particularly useful for reducing high-frequency artifacts., (Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

To explore the possibility of decreasing the radiation dose during digital tomosynthesis (DT) for arthroplasty, we compared the image qualities of several reconstruction algorithms, such as filtered back projection (FBP) and two iterative reconstruction (IR), methods maximum likelihood expectation maximization (MLEM) and the simultaneous iterative reconstruction technique (SIRT) under different radiation doses. The three algorithms were implemented using a DT system and experimentally evaluated by contrast-to-noise ratio (CNR), artifact spread function (ASF), and power spectrum measurements on a prosthesis phantom. The CNR and ASF data were statistically analyzed by a one-way analysis of variance. The effectiveness of each technique for enhancing the visibility of the prosthesis phantom was quantified by the CNR (reference dose vs. 20 % reduced dose in FBP, P = 0.62; reference vs. 37 % reduced dose in FBP, P = 0.16; reference vs. 55 % reduced dose in FBP, P < 0.05; reference vs. 20 % reduced dose in IR, P = 0.92; reference vs. 37 % reduced dose in IR, P = 0.40; reference vs. 55 % reduced dose in IR, P < 0.05) and ASF (reference dose vs. 20 % reduced dose in FBP, P = 0.25; reference vs. 37 and 55 % reduced dose in FBP, P < 0.05; reference vs. 20 % reduced dose in IR, P = 0.16; reference vs. 37 and 55 % reduced dose in IR, P < 0.05). The power spectra under the reference and reduced doses are equivalent. In this phantom study, the radiation dose of the reference dose could be decreased by 20 % with FBP and IR for consideration of common factors.

To investigate methods to reduce metal artifacts during digital tomosynthesis for arthroplasty, we evaluated five algorithms with and without metal artifact reduction (MAR)-processing tested under different radiation doses (0.54, 0.47, and 0.33 mSv): adaptive steepest descent projection onto convex sets (ASD-POCS), simultaneous algebraic reconstruction technique total variation (SART-TV), filtered back projection (FBP), maximum likelihood expectation maximization (MLEM), and SART. The algorithms were assessed by determining the artifact index (AI) and artifact spread function (ASF) on a prosthesis phantom. The AI data were statistically analyzed by two-way analysis of variance. Without MAR-processing, the greatest degree of effectiveness of the MLEM algorithm for reducing prosthetic phantom-related metal artifacts was achieved by quantification using the AI (MLEM vs. ASD-POCS, SART-TV, SART, and FBP; all P < 0.05). With MAR-processing, the greatest degree of effectiveness of the MLEM, ASD-POCS, SART-TV, and SART algorithms for reducing prosthetic phantom-related metal artifacts was achieved by quantification using the AI (MLEM, ASD-POCS, SART-TV, and SART vs. FBP; all P < 0.05). When assessed by ASF, metal artifact reduction was largest for the MLEM algorithm without MAR-processing and ASD-POCS, SART-TV, and SART algorithm with MAR-processing. In ASF, the effect of metal artifact reduction was always greater at reduced radiation doses, regardless of which reconstruction algorithm with and without MAR-processing was used. In this phantom study, the MLEM algorithm without MAR-processing and ASD-POCS, SART-TV, and SART algorithm with MAR-processing gave improved metal artifact reduction. [ABSTRACT FROM AUTHOR]

In this study, a novel combination of hybrid generative adversarial networks (GANs) comprising cycle-consistent GAN, pix2pix, and (mask pyramid network) MPN (CGpM-metal artifact reduction [MAR]), was developed using projection data to reduce metal artifacts and the radiation dose during digital tomosynthesis. The CGpM-MAR algorithm was compared with the conventional filtered back projection (FBP) without MAR, FBP with MAR, and convolutional neural network MAR. The MAR rates were compared using the artifact index (AI) and Gumbel distribution of the largest variation analysis using a prosthesis phantom at various radiation doses. The novel CGpM-MAR yielded an adequately effective overall performance in terms of AI. The resulting images yielded good results independently of the type of metal used in the prosthesis phantom (p < 0.05) and good artifact removal at 55% radiation-dose reduction. Furthermore, the CGpM-MAR represented the minimum in the model with the largest variation at 55% radiation-dose reduction. Regarding the AI and Gumbel distribution analysis, the novel CGpM-MAR yielded superior MAR when compared with the conventional reconstruction algorithms with and without MAR at 55% radiation-dose reduction and presented features most similar to the reference FBP. CGpM-MAR presents a promising method for metal artifact and radiation-dose reduction in clinical practice. [ABSTRACT FROM AUTHOR]

The article describes two cases of revision total hip replacement therapy (THR) involving the use of intramedullary and onlay cortical strut allografts with a cementless interlocking distal femoral long stem to achieve favorable fixation stability. It states that the use of either a megaprosthesis or a segmental cortical allograft as an allograft-prosthesis composite is the accepted reconstruction method for severe proximal femoral bone deficiency after repeated re-THR.