Metal artifact reduction in spectral computed tomography for intracavity brachytherapy in cervical cancer patients: a prospective study

Q: Which combination performed best and why?

The 140 keV + MAR combination provided the best overall balance, showing the strongest artifact reduction along with improved SNR/CNR and superior contouring consistency (highest DSC and lowest HD95).

Sep 30, 2026

Uploaded by Kyle

Study evaluates the effectiveness of combining virtual monochromatic images (VMI) with metal artifact reduction (MAR) algorithms to mitigate metal artifacts in cervical cancer patients undergoing intracavitary brachytherapy. Fifty patients underwent spectral CT, reconstructing VMI + MAR and VMI + no-MAR across 40–140 keV to compare attenuation, noise, signal-to-noise ratio, contrast-to-noise ratio, and artifact index. Image quality was also rated on a 5-point Likert scale, while geometric distortion and contouring consistency were quantified using applicator axis measurements, Dice Similarity Coefficient, and HD95. Results show VMI + MAR markedly reduces artifact index and improves SNR/CNR, with 140 keV + MAR yielding the best balance for artifact reduction, geometric accuracy, and contouring suitability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Materials and methods

Results

Conclusions

Introduction

Rationale and clinical context

Impact of metal artifacts on CT-based planning

Dose calculation considerations

Sun et al. Radiation Oncology (2026) 21:3 [https://doi.org/10.1186/s13014-025-02767-9](https://doi.org/10.1186/s13014-025-02767-9) Radiation Oncology RESEARCH Open Access Metal artifact reduction in spectral computed tomography for intracavity brachytherapy in cervical cancer patients: a prospective study Yuliang Sun 1†, Yining Chen2†, Zheng Zeng 1†, Bing Zhou 1, Haoran Xu 1, Junfang Yan 1*, Ke Hu 1* and Fuquan Zhang3* Abstract Background This study aims to evaluate the effectiveness of combining virtual monochromatic images (VMI) with metal artifact reduction (MAR) algorithms in reducing metal artifacts in cervical cancer patients undergoing intracavitary brachytherapy. Materials and methods Fifty cervical cancer patients scheduled for intracavitary brachytherapy underwent spectral computed tomography (CT) images. VMI + MAR/no-MAR were reconstructed at energies ranging from 40 to 140 keV. CT attenuation and image noise (standard deviation) were measured to calculate the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) for the most prominent artifacts, and the artifact index (AI) for the cervix, bladder, and rectum. Objective metrics were compared between the VMI + MAR and VMI + no-MAR groups. Subjective image quality was evaluated using a 5-point Likert scale, focusing on artifact reduction, soft tissue contrast, and contouring preference. Geometric distortion was assessed by measuring the long axis, short axis, and long-to-short axis ratio (L/S) of the titanium applicator. Contouring consistency was quantified using the Dice Similarity Coefficient (DSC) and 95th percentile Hausdorff Distance (HD95) between two radiation oncologists. Results VMI + MAR significantly reduced the AI for the cervix (relative 34. 74%-88 . 51% reduction) and rectum (relative 11. 31%-81 . 35% reduction) compared to VMI + no-MAR across all energies (all p < 0. 05) . SNR increased from 0.70–1.00 to 1.75–1. 97, and CNR improved significantly from 90 keV onwards (p < 0. 05) . 140 keV + MAR achieved the highest SNR and CNR with the lowest AI. Subjective assessment further confirmed that 140 keV + MAR offered the best balance between artifact reduction and soft tissue contrast, with significantly higher scores for artifact reduction and contouring preference (p < 0. 001) . Distortion analysis showed that with increasing VMI energy, long (40-140 keV: from 8.10 to 6.17 mm) and short axes (40-140 keV: from 6.93 to 5.55 mm) decreased, and L/S approached †Yuliang Sun, Yining Chen and Zheng Zeng contributed equally to this work. *Correspondence: Junfang Yan [yanjunfang@pumch.cn](yanjunfang@pumch.cn)[ ](yanjunfang@pumch.cn)Ke Hu [huke8000@126.com](huke8000@126.com)[ ](huke8000@126.com)Fuquan Zhang [zhangfq@pumch.cn](zhangfq@pumch.cn) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. Sun et al. Radiation Oncology (2026) 21:3 Page 2 of 13 1 (p < 0. 001) . Contouring consistency analysis further demonstrated that 140 keV + MAR achieved the highest DSC and lowest HD95 among all energy-MAR combinations, indicating superio

FAQs

Which combination performed best and why?

The 140 keV + MAR combination provided the best overall balance, showing the strongest artifact reduction along with improved SNR/CNR and superior contouring consistency (highest DSC and lowest HD95).

Sep 30, 2026

Uploaded by Kyle