Objective: The aim of this study was to evaluate commercial metal artefact reduction (MAR) techniques in X-ray CT imaging of hip prostheses. Methods: Monoenergetic reconstructions of dual-energy CT (DECT) data and several different MAR algorithms, combined with single-energy CT or DECT, were evaluated by imaging a bilateral hip prosthesis phantom. The MAR images were compared with uncorrected images based on CT number accuracy and noise in different regions of interest. Results: The three MAR algorithms studied implied a general noise reduction (up to 67%, 74% and 77%) and an improvement in CT number accuracy, both in regions close to the prostheses and between the two prostheses. The application of monoenergetic reconstruction, without any MAR algorithm, did not decrease the noise in the regions close to the prostheses to the same extent as did the MAR algorithms and even increased the noise in the region between the prostheses. Conclusion: The MAR algorithms evaluated generally improved CT number accuracy and substantially reduced the noise in the hip prostheses phantom images, both close to the prostheses and between the two prostheses. The study showed that the monoenergetic reconstructions evaluated did not sufficiently reduce the severe metal artefact caused by large orthopaedic implants. Advances in knowledge: This study evaluates several commercially available MAR techniques in CT imaging of large orthopaedic implants.Images degraded by metal artefacts are a common problem in X-ray CT imaging. Artefacts caused by the presence of metallic implants in the CT scanned volume, such as hip prostheses or dental fillings, appear as dark and bright streaks across the reconstructed image. Metal artefacts can severely degrade the image quality and hence limit the diagnostic value of a CT scan. 1 Hip prostheses cause severe artefacts when present in a CT scanned volume, and the resulting degradation of image quality leads to difficulties in diagnosing fractures, implant loosening or pathology in organs or soft tissue in the pelvic area. If CT images containing hip prostheses are used in radiotherapy treatment planning for tissue heterogeneity correction, the metal artefacts may introduce inaccuracies in dose calculations.Metal artefacts in CT imaging are mainly caused by beam hardening and photon starvation. Photon starvation artefacts are created when X-rays traverse materials with high attenuation coefficients, which leads to an insufficient amount of photons reaching the detectors and results in very noisy projections. The noise is magnified in the reconstruction process and the resulting streaks can be seen in the reconstructed image. Beam hardening refers to the fact that low-energy photons are attenuated to a greater degree than high-energy photons when passing through the scanned volume. This effect is more pronounced when the X-ray beam passes through high-density materials such as metals.

• Low-dose CT has a higher diagnostic accuracy than radiography. • A systematic review shows that CT has better diagnostic accuracy than radiography. • Radiography has no place in the workup of acute non-traumatic abdominal pain.

Qualitative evaluation of the usefulness of several MAR techniques from different vendors in CT imaging of hip prosthesis.

Low dose lumbar spine CT at about 1 mSv has superior image quality to lumbar spine radiography with more anatomical and diagnostic information.

Low-dose lumbar spine CT thus opens a possibility to substitute lumbar spine radiography with CT without obvious increase in radiation dose.