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Low-dose CT with metal artifact reduction in arthroplasty imaging: a cadaveric and clinical study

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Abstract

Objective

To determine whether a simulated low-dose metal artifact reduction (MAR) CT technique is comparable with a clinical dose MAR technique for shoulder arthroplasty evaluation.

Materials and methods

Two shoulder arthroplasties in cadavers and 25 shoulder arthroplasties in patients were scanned using a clinical dose (140 kVp, 300 qrmAs); cadavers were also scanned at half dose (140 kVp, 150 qrmAs). Images were reconstructed using a MAR CT algorithm at full dose and a noise-insertion algorithm simulating 50% dose reduction. For the actual and simulated half-dose cadaver scans, differences in SD for regions of interest were assessed, and streak artifact near the arthroplasty was graded by 3 blinded readers. Simulated half-dose scans were compared with full-dose scans in patients by measuring differences in implant position and by comparing readers’ grades of periprosthetic osteolysis and muscle atrophy.

Results

The mean difference in SD between actual and simulated half-dose methods was 2.42 HU (95% CI [1.4, 3.4]). No differences in streak artifact grades were seen in 13/18 (72.2%) comparisons in cadavers. In patients, differences in implant position measurements were within 1° or 1 mm in 149/150 (99.3%) measurements. The inter-reader agreement rates were nearly identical when readers were using full-dose (77.3% [232/300] for osteolysis and 76.9% [173/225] for muscle atrophy) and simulated half-dose (76.7% [920/1200] for osteolysis and 74.0% [666/900] for muscle atrophy) scans.

Conclusion

A simulated half-dose MAR CT technique is comparable both quantitatively and qualitatively with a standard-dose technique for shoulder arthroplasty evaluation, demonstrating that this technique could be used to reduce dose in arthroplasty imaging.

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Acknowledgments

We thank Wadih Karim, RT, (Cleveland Clinic) for data collection and Megan Griffiths (Cleveland Clinic) for manuscript editing and submission.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Naveen Subhas & Parthiv N. Mehta

  2. Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Bong J. Jun

  3. Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Eric T. Ricchetti & Joseph P. Iannotti

  4. Department of Biostatistics, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Nancy A. Obuchowski

  5. Siemens Medical Solutions USA, Inc., Malvern, PA, 19355, USA

    Andrew N. Primak

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  1. Naveen Subhas
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Corresponding author

Correspondence to Naveen Subhas.

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Conflict of interest

Naveen Subhas receives research support from Siemens Healthcare; Andrew Primak is an employee of Siemens Healthcare; Eric T. Ricchetti receives royalties from and is a consultant and paid speaker for DJO Surgical; Joseph P. Iannotti receives royalties from DePuy Synthes, DJO Surgical, Wright Medical, and Arthex and is a consultant for DJO Surgical; Bong Jae Jun, Parthiv Mehta, and Nancy Obuchowski have no disclosures.

Ethical approval

This study, which consisted of a cadaver protocol validation and a retrospective comparison of images obtained from patients, was approved by our institutional review board. Given the parameters of the study, it was determined that individual consent was not required from patients. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Subhas, N., Jun, B.J., Mehta, P.N. et al. Low-dose CT with metal artifact reduction in arthroplasty imaging: a cadaveric and clinical study. Skeletal Radiol 50, 955–965 (2021). https://doi.org/10.1007/s00256-020-03643-1

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  • DOI: https://doi.org/10.1007/s00256-020-03643-1

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