Björn W. Kreher

Fuxin Fan, Yangkong Wang, Ludwig Ritschl et al.

The existence of metallic implants in projection images for cone-beam computed tomography (CBCT) introduces undesired artifacts which degrade the quality of reconstructed images. In order to reduce metal artifacts, projection inpainting is an essential step in many metal artifact reduction algorithms. In this work, a hybrid network combining the shift window (Swin) vision transformer (ViT) and a convolutional neural network is proposed as a baseline network for the inpainting task. To incorporate metal information for the Swin ViT-based encoder, metal-conscious self-embedding and neighborhood-embedding methods are investigated. Both methods have improved the performance of the baseline network. Furthermore, by choosing appropriate window size, the model with neighborhood-embedding could achieve the lowest mean absolute error of 0.079 in metal regions and the highest peak signal-to-noise ratio of 42.346 in CBCT projections. At the end, the efficiency of metal-conscious embedding on both simulated and real cadaver CBCT data has been demonstrated, where the inpainting capability of the baseline network has been enhanced.

Tristan M. Gottschalk, Andreas Maier, Florian Kordon et al.

The positive outcome of a trauma intervention depends on an intraoperative evaluation of inserted metallic implants. Due to occurring metal artifacts, the quality of this evaluation heavily depends on the performance of so-called Metal Artifact Reduction methods (MAR). The majority of these MAR methods require prior segmentation of the inserted metal objects. Therefore, typically a rather simple thresholding-based segmentation method in the reconstructed 3D volume is applied, despite some major disadvantages. With this publication, the potential of shifting the segmentation task to a learning-based, view-consistent 2D projection-based method on the downstream MAR's outcome is investigated. For segmenting the present metal, a rather simple learning-based 2D projection-wise segmentation network that is trained using real data acquired during cadaver studies, is examined. To overcome the disadvantages that come along with a 2D projection-wise segmentation, a Consistency Filter is proposed. The influence of the shifted segmentation domain is investigated by comparing the results of the standard fsMAR with a modified fsMAR version using the new segmentation masks. With a quantitative and qualitative evaluation on real cadaver data, the investigated approach showed an increased MAR performance and a high insensitivity against metal artifacts. For cases with metal outside the reconstruction's FoV or cases with vanishing metal, a significant reduction in artifacts could be shown. Thus, increases of up to roughly 3 dB w.r.t. the mean PSNR metric over all slices and up to 9 dB for single slices were achieved. The shown results reveal a beneficial influence of the shift to a 2D-based segmentation method on real data for downstream use with a MAR method, like the fsMAR.

Fuxin Fan, Björn Kreher, Holger Keil et al.

Fiducial markers are commonly used in navigation assisted minimally invasive spine surgery (MISS) and they help transfer image coordinates into real world coordinates. In practice, these markers might be located outside the field-of-view (FOV), due to the limited detector sizes of C-arm cone-beam computed tomography (CBCT) systems used in intraoperative surgeries. As a consequence, reconstructed markers in CBCT volumes suffer from artifacts and have distorted shapes, which sets an obstacle for navigation. In this work, we propose two fiducial marker detection methods: direct detection from distorted markers (direct method) and detection after marker recovery (recovery method). For direct detection from distorted markers in reconstructed volumes, an efficient automatic marker detection method using two neural networks and a conventional circle detection algorithm is proposed. For marker recovery, a task-specific learning strategy is proposed to recover markers from severely truncated data. Afterwards, a conventional marker detection algorithm is applied for position detection. The two methods are evaluated on simulated data and real data, both achieving a marker registration error smaller than 0.2 mm. Our experiments demonstrate that the direct method is capable of detecting distorted markers accurately and the recovery method with task-specific learning has high robustness and generalizability on various data sets.

Tristan M. Gottschalk, Andreas Maier, Florian Kordon et al.

Metal implants that are inserted into the patient's body during trauma interventions cause heavy artifacts in 3D X-ray acquisitions. Metal Artifact Reduction (MAR) methods, whose first step is always a segmentation of the present metal objects, try to remove these artifacts. Thereby, the segmentation is a crucial task which has strong influence on the MAR's outcome. This study proposes and evaluates a learning-based patch-wise segmentation network and a newly proposed Consistency Check as post-processing step. The combination of the learned segmentation and Consistency Check reaches a high segmentation performance with an average IoU score of 0.924 on the test set. Furthermore, the Consistency Check proves the ability to significantly reduce false positive segmentations whilst simultaneously ensuring consistent segmentations.