The Effectiveness of a Smart Metal Artifact Reduction Technique in Chest CT of Patients with Cardiac Implantable Electronic Devices

Purpose To evaluate whether Smart Metal Artifact Reduction (SMAR) used in combination with adaptive statistical iterative reconstruction (ASIR) improves chest CT image quality in patients with cardiac implantable electronic devices (CIEDs), compared with ASIR alone. Methods In this retrospective study, 30 CIED patients who underwent chest CT with both ASIR and ASIR + SMAR reconstructions were included. Two readers (16 and 10 years of chest CT experience) assessed subjective image quality and artifacts on soft-tissue, bone, and lung windows; objective artifact load was quantified using the standard deviation of Hounsfield Units in regions of interest adjacent to the generator. Scans were acquired on a single-source 512-slice CT system with standard thoracic parameters; SMAR reconstructions used vendor “thorax” settings. Results ASIR + SMAR reduced peri-device artifact magnitude relative to ASIR alone on objective measurements and improved overall diagnostic image quality across evaluated windows (average of two readers). However, far-field lung streaks were observed in 13 out of 30 patients, and in 5 cases, MAR-related artifacts limited assessment, indicating distance-dependent effects. Conclusion SMAR complements ASIR by enhancing depiction of the device and near-to mid-field regions, increasing diagnostic confidence. Radiologists should review ASIR-only images for distant lung parenchyma, where occasional MAR-induced streaks may limit evaluation.