Metal Artifact Reduction in Lumbar Spine Instrumentation

PCD CT with VMI 120 or iMAR achieved artifact reduction comparable to EID CT for lumbar spine metal artifact reduction, at nearly half the radiation dose. Combining VMI120 + iMAR provided the strongest qualitative and quantitative artifact reduction, but at the cost of the lowest cortical and trabecular bone visibility. 140 kVp acquisitions should be favored over 100 kVp acquisitions in PCD to reduce the occurrence of "dark zone" and "silhouette artifacts", suggesting a fixed tube voltage instead of an automatic tube voltage setting in instrumented lumbar spine imaging. VMI reconstruction of tin-filtered lumbar spine CT effectively reduces metal artifacts, with PCD favored over EID for its inherent spectral capabilities and the potential for substantial dose reduction.