A fidelity-embedded learning for metal artifact reduction in dental CBCT

Purpose Dental cone-beam computed tomography (CBCT) has been increasingly used for dental and maxillofacial imaging. However, the presence of metallic inserts, such as implants, crowns, and dental braces, violates the CT model assumption, which leads to severe metal artifacts in the reconstructed CBCT image, resulting in the degradation of diagnostic performance. In this study, we used deep learning to reduce metal artifacts. Methods The metal artifacts, appearing as streaks and shadows, are nonlocal and highly associated with various factors, including the geometry of metallic inserts, energy-dependent attenuation, and energy spectrum of the incident X-ray beam, making it difficult to learn their complicated structures directly. To provide a step-by-step environment in which deep learning can be trained, we propose an iterative learning approach in which the network at each iteration step learns the correction error caused by the previous network, while enforcing the data fidelity in the projection domain. To generate a realistic paired training dataset, metal-free CBCT scans were collected from patients without metallic inserts, and then simulated metal projection data were added to generate the corresponding metal-corrupted projection data. Results The feasibility of the proposed method was investigated in clinical metal-affected CBCT scans, as well as simulated metal-affected CBCT scans. The results show that the proposed method significantly reduces metal artifacts while preserving the morphological structures near metallic objects and outperforms direct image domain learning. Conclusion The proposed fidelity-embedded learning can effectively reduce metal artifacts in dental CBCT compared with direct image domain learning.