CT metal artifact reduction method correcting for beam hardening and missing projections.

We present and validate a computed tomography (CT) metal artifact reduction method that is effective for a wide spectrum of clinical implant materials. Projections through low-Z implants such as titanium were corrected using a novel physics correction algorithm that reduces beam hardening errors. In the case of high-Z implants (dental fillings, gold, platinum), projections through the implant were considered missing and regularized iterative reconstruction was performed. Both algorithms were combined if multiple implant materials were present. For comparison, a conventional projection interpolation method was implemented. In a blinded and randomized evaluation, ten radiation oncologists ranked the quality of patient scans on which the different methods were applied. For scans that included low-Z implants, the proposed method was ranked as the best method in 90% of the reviews. It was ranked superior to the original reconstruction (p = 0.0008), conventional projection interpolation (p < 0.0001) and regularized limited data reconstruction (p = 0.0002). All reviewers ranked the method first for scans with high-Z implants, and better as compared to the original reconstruction (p < 0.0001) and projection interpolation (p = 0.004). We conclude that effective reduction of CT metal artifacts can be achieved by combining algorithms tailored to specific types of implant materials.