Evaluation of digital tomosynthesis reconstruction algorithms used to reduce metal artifacts for arthroplasty: A phantom study

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.