Does the metal artifact reduction algorithm activation mode influence the magnitude of artifacts in CBCT images

Purpose: This study was conducted to assess the effectiveness of a metal artifact reduction (MAR) algorithm activated at different times during cone-beam computed tomography (CBCT) acquisition on the magnitude of artifacts generated by a zirconium implant. Materials and Methods: Volumes were obtained with and without a zirconium implant in a human mandible, using the OP300 Maxio unit. Three modes were tested: without MAR, with MAR activated after acquisition, and with MAR activated before acquisition. Artifacts were assessed in terms of the standard deviation (SD) of gray values and the contrast-to-noise ratio (CNR) in 6 regions of interest with different distances (10 to 35 mm, from the nearest to the farthest) and angulations (70 degrees to 135 degrees ) from the implant region. Results: In the acquisitions without MAR, the regions closer to the implant (10 and 15 mm) had a higher SD and lower CNR than the farther regions. When MAR was activated (before or after), SD values did not differ among the regions (P>0.05). The region closest to the implant presented a significantly lower CNR in the acquisitions without MAR than when MAR was activated after the acquisition; however, activating MAR before the acquisition did not yield significant differences from either of the other conditions. Conclusion: Both modes of MAR activation were effective in decreasing the magnitude of CBCT artifacts, especially when the effects of the artifacts were more noticeable.