View-Consistent Metal Segmentation in the Projection Domain for Metal Artifact Reduction in CBCT -- An Investigation of Potential Improvement

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.