Simulation-Driven Training of Vision Transformers Enabling Metal Segmentation in X-Ray Images

In several image acquisition and processing steps of X-ray radiography, knowledge of the existence of metal implants and their exact position is highly beneficial (e.g. dose regulation, image contrast adjustment). Another application which would benefit from an accurate metal segmentation is cone beam computed tomography (CBCT) which is based on 2D X-ray projections. Due to the high attenuation of metals, severe artifacts occur in the 3D X-ray acquisitions. The metal segmentation in CBCT projections usually serves as a prerequisite for metal artifact avoidance and reduction algorithms. Since the generation of high quality clinical training is a constant challenge, this study proposes to generate simulated X-ray images based on CT data sets combined with self-designed computer aided design (CAD) implants and make use of convolutional neural network (CNN) and vision transformer (ViT) for metal segmentation. Model test is performed on accurately labeled X-ray test datasets obtained from specimen scans. The CNN encoder-based network like U-Net has limited performance on cadaver test data with an average dice score below 0.30, while the metal segmentation transformer with dual decoder (MST-DD) shows high robustness and generalization on the segmentation task, with an average dice score of 0.90. Our study indicates that the CAD model-based data generation has high flexibility and could be a way to overcome the problem of shortage in clinical data sampling and labelling. Furthermore, the MST-DD approach generates a more reliable neural network in case of training on simulated data.

View-Consistent Metal Segmentation in the Projection Domain for Metal Artifact Reduction in CBCT -- An Investigation of Potential Improvement

The positive outcome of a trauma intervention depends on an intraoperative evaluation of inserted metallic implants. Due to occurring metal artifacts, the quality of this evaluation heavily depends on the performance of so-called Metal Artifact Reduction methods (MAR). The majority of these MAR methods require prior segmentation of the inserted metal objects. Therefore, typically a rather simple thresholding-based segmentation method in the reconstructed 3D volume is applied, despite some major disadvantages. With this publication, the potential of shifting the segmentation task to a learning-based, view-consistent 2D projection-based method on the downstream MAR's outcome is investigated. For segmenting the present metal, a rather simple learning-based 2D projection-wise segmentation network that is trained using real data acquired during cadaver studies, is examined. To overcome the disadvantages that come along with a 2D projection-wise segmentation, a Consistency Filter is proposed. The influence of the shifted segmentation domain is investigated by comparing the results of the standard fsMAR with a modified fsMAR version using the new segmentation masks. With a quantitative and qualitative evaluation on real cadaver data, the investigated approach showed an increased MAR performance and a high insensitivity against metal artifacts. For cases with metal outside the reconstruction's FoV or cases with vanishing metal, a significant reduction in artifacts could be shown. Thus, increases of up to roughly 3 dB w.r.t. the mean PSNR metric over all slices and up to 9 dB for single slices were achieved. The shown results reveal a beneficial influence of the shift to a 2D-based segmentation method on real data for downstream use with a MAR method, like the fsMAR.

Learning-Based Patch-Wise Metal Segmentation with Consistency Check

Metal implants that are inserted into the patient's body during trauma interventions cause heavy artifacts in 3D X-ray acquisitions. Metal Artifact Reduction (MAR) methods, whose first step is always a segmentation of the present metal objects, try to remove these artifacts. Thereby, the segmentation is a crucial task which has strong influence on the MAR's outcome. This study proposes and evaluates a learning-based patch-wise segmentation network and a newly proposed Consistency Check as post-processing step. The combination of the learned segmentation and Consistency Check reaches a high segmentation performance with an average IoU score of 0.924 on the test set. Furthermore, the Consistency Check proves the ability to significantly reduce false positive segmentations whilst simultaneously ensuring consistent segmentations.