The effect of the reconstruction algorithm for the pulmonary nodule detection under the metal artifact caused by a pacemaker

The aim was to compare the effects of metal artifacts from a pacemaker on pulmonary nodule detection among computed tomography (CT) images reconstructed using filtered back projection (FBP), single-energy metal artifact reduction (SEMAR), and forward-projected model-based iterative reconstruction solution (FIRST). Nine simulated nodules were placed inside a chest phantom with a pacemaker. CT images reconstructed using FBP, SEMAR, and FIRST were acquired at low and standard dose, and were evaluated by 2 independent radiologists. FIRST demonstrated the most significantly improved metal artifact and nodule detection on low dose CT (P < .0032), except at 10 mA and 5-mm thickness. At standard-dose CT, SEMAR showed the most significant metal artifact reduction (P < .00001). In terms of nodule detection, no significant differences were observed between FIRST and SEMAR (P = .161). With a pacemaker present, FIRST showed the best nodule detection ability at low-dose CT and SEMAR is comparable to FIRST at standard dose CT.