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Objective To quantify metal artifact reduction using 130 keV virtual monochromatic imaging (VMI) with and without orthopedic metal artifact reduction (O-MAR) in total hip arthroplasty. Methods Conventional polychromatic images and 130 keV VMI of a phantom with pellets representing bone with unilateral or bilateral prostheses were reconstructed with and without O-MAR on a dual-layer CT. Pellets were categorized as unaffected, mildly affected and severely affected. Results When 130 keV VMI with O-MAR was compared to conventional imaging with O-MAR, a relative metal artifact reduction in CT values, contrast-to-noise (CNR), signal-to-noise (SNR) and noise in mildly affected pellets (67%, 74%, 48%, 68%, respectively;  p  &lt; 0.05) was observed but no significant relative metal artifact reduction in severely affected pellets. Comparison between 130 keV VMI without O-MAR and conventional imaging with O-MAR showed relative metal artifact reduction in CT values, CNR, SNR and noise in mildly affected pellets (92%, 72%, 38%, 51%, respectively;  p  &lt; 0.05) but negative relative metal artifact reduction in CT values and noise in severely affected pellets (− 331% and -223%, respectively;  p  &lt; 0.05), indicating aggravation of metal artifacts. Conclusion Overall, VMI of 130 keV with O-MAR provided the strongest metal artifact reduction.

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Quantitative analysis of metal artifact reduction in total hip arthroplasty using virtual monochromatic imaging and orthopedic metal artifact reduction, a phantom study