Small metal artifact detection and inpainting in cardiac CT images

Background: Quantification of cardiac motion on pre-treatment CT imaging for stereotactic arrhythmia radiotherapy patients is difficult due to the presence of image artifacts caused by metal leads of implantable cardioverter-defibrillators (ICDs). New methods are needed to accurately reduce the metal artifacts in already reconstructed CTs to recover the otherwise lost anatomical information. Purpose: To develop a methodology to automatically detect metal artifacts in cardiac CT scans and inpaint the affected volume with anatomically consistent structures and values. Methods: ECG-gated 4DCT scans of 12 patients who underwent cardiac radiation therapy for treating ventricular tachycardia were collected. The metal artifacts in the images were manually contoured. A 2D U-Net deep learning (DL) model was developed to segment the metal artifacts. A dataset of synthetic CTs was prepared by adding metal artifacts from the patient images to artifact-free CTs. A 3D image inpainting DL model was trained to refill the metal artifact portion in the synthetic images with realistic values. The inpainting model was evaluated by analyzing the automated segmentation results of the four heart chambers on the synthetic dataset. Additionally, the raw cardiac patient cases were qualitatively inspected. Results: The artifact detection model produced a Dice score of 0.958 +- 0.008. The inpainting model was able to recreate images with a structural similarity index of 0.988 +- 0.012. With the chamber segmentations improved surface Dice scores from 0.684 +- 0.247 to 0.964 +- 0.067 and the Hausdorff distance reduced from 3.4 +- 3.9 mm to 0.7 +- 0.7 mm. The inpainting model's use on cardiac patient CTs was visually inspected and the artifact-inpainted images were visually plausible. Conclusion: We successfully developed two deep models to detect and inpaint metal artifacts in cardiac CT images.