Application of streak metal artifact reduction technique in cone-beam computed tomography guided percutaneous transthoracic needle biopsy

BACKGROUND Metallic artifacts from coaxial needles can severely interfere with the precision of cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB), particularly in assessing vital anatomical structures around small lesions. AIM To evaluate the clinical application of a streak metal artifact reduction technique (SMART) in CBCT-PTNB procedures. METHODS We retrospectively analyzed data from 68 patients (73 CBCT scans) undergoing CBCT-guided PTNB between March 2023 and December 2024. Image quality was compared among original reconstructed CBCT images, those iteratively reconstructed using SMART with a full volume of interest (VOI) (SMART-Full), and those with a small VOI containing only the coaxial needle (SMART-Small). Evaluations focused on artifact types, puncture needle diameter measurements, and density metrics within the region of interest (ROI). RESULTS SMART-Full reconstruction significantly reduced radial, streak, and dark stripe artifacts (P < 0.001) compared to original CBCT, with superior performance in puncture needle diameter measurement and ROI minimum and average density indicators (P < 0.001). The incidence of dark streak artifacts decreased from 71 cases in original CBCT to 26 cases in SMART-Full. Additionally, SMART-Full was more effective than SMART-Small in artifact elimination (P < 0.001). CONCLUSION SMART technology effectively reduces metal artifacts, enabling clearer visualization of hidden anatomical structures. Through quantitative analysis, this study confirms the clinical value of SMART in CBCT-guided PTNB, providing a technical reference for precise diagnosis and treatment of small pulmonary lesions.