CBCT-Faults & Artifacts

By Dr. Poulomi Bhakta

 CONTENTS
FAULTS & ARTIFACTS

CONCLUSION

REFERENCES

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 FAULTS AND ARTIFACTS
• It is important to understand the basic concept of a fault and an
artifact.
• Fault is an imperfection, a mistake or error, where flaws will
hinder interpretation of the radiograph, whereas an artifact is
any distortion or error in the image that is unrelated to the
(tissues/organs of the) subject being studied.
• Artifacts can be classified according to their cause.
• It is important for a radiologist to be able to recognize and
diagnose the faults and artifacts in the image and to understand
the cause, thus preventing their occurrence in subsequent images.

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CLASSIFICATION OF IMAGE DETERIORATING
FACTORS IN CBCT
Beam related
Artifacts

Unsharpness
Patient related
1. ARTIFACTS
Artifacts
Double Image
Scanner related
Artifacts Ring Artifacts

Foreign Objects

2. IMAGE NOISE

3. POOR SOFT TISSUE

CONTRAST
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 Beam related Artifacts

Beam Full mouth

Scatter
Hardening restoration
(metallic)
Artifact
Cone Shaped Beam Exponential Photon
Related Faults Edge Gradient Deprivation
Effects

Cupping Streaks
Effect and Bands Partial Under Cone Beam
volume sampling Effect
Averaging
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Beam-related artifacts

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 Beam hardening artifact
• The most prominent artifacts seen in CBCT images are beam hardening
artifacts.

• These are made by heavy metal restorations because of their high

density.

• Beam hardening artifact is seen because the mean energy of beam

increases as the lower energy photons are absorbed more in comparison
to higher energy photons.

• This shows effects in the distortion of metallic structures as a result of

disturbance in the reconstruction process.

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• This phenomenon produces two types of
artifacts:

a. Cupping artifacts: They are seen as a

distortion of metallic structures as a result
of differential absorption .

 b. Streaks and dark bands: They can be

seen between two dense objects . They can
significantly deteriorate the image quality
and are more prominently seen in the axial
planes and 3D reconstruction images .
(a) Image showing: 1. cupping
effect, 2. streaks, and 3. and4.
dark bands seen as a result of
beam hardening.
(b) Beam hardening effect seen
on 3D image

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 Cone-shaped beam-related faults
• The cone beam projection geometry and the image
reconstruction method produce three types of
artifacts:
• a. Partial volume averaging: It occurs when the
selected voxel resolution of the scan is greater than
the spatial or contrast resolution of the object to be
imaged. Partial volume averaging artifacts occur in
regions where surfaces are rapidly changing in the
z direction (e.g. in the temporal bone).
• b. Under sampling: This is a type of aliasing
artifact. It is seen when very few basic projections
are provided for the reconstruction. Under sampling due
• c. Cone beam effect: This type of artifact is seen to insufficient basic
in the peripheral portions of the scan and is seen projections.
because of the divergence of X-rays in those areas.
The outcome of cone beam effect is image
distortion, streaks, and peripheral noise.
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 Scatter
• Scattering is caused by those photons that are diffracted from their
original path after interaction with matter.

• Most of the scattered radiation is produced omnidirectionally and is

recorded by pixels on the cone beam area detector, which does not
reflect the actual attenuation of the object within a specific path of
the X-ray beam.

• The resultant outcome increases the image noise and reduces

contrast. Reconstruction error is proportional to the amount of scatter.

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 Exponential edge gradient effect
• This effect is caused because of the sharp edges of the metallic
crown borders producing high contrast, as it reduces the
computed density value.

• As sharp edges of high contrast may commonly occur in the

oral cavity, e.g. at metallic crown borders, this artifact also has
to be considered in dental CBCT.

• The EEGE is known to cause streaks tangent to long straight

edges in the projection direction.
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 Photon deprivation
• This is a result of severe beam hardening,
generally seen next to titanium implants or
other heavy metal restorations.

• Due to the high density of metallic

restorations, sufficient photons do not reach
the detector and a complete void exists in the
image, which is known as photon starvation.

• In particular, photon deprivation effects can Image showing: 1. photon

deprivation, 2. streaks, and
present as apparent “pseudo” fracture on 3. pseudofracture

axial images .
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 Full mouth restoration
(metallic) artifact
• This artifact is seen in patients
with full mouth metallic
restorations or long bridges.
Image degradation due to full
• This is the combination of
mouth metallic restorations.
streaks, dark bands, and photon Image also shows:
deprivation to the extent that the 1. pseudofracture and 2. ring
image loses all of its diagnostic artifact
quality .
• Patients with long metallic
bridges, cast partial dentures, and
Metallic artifact
full mouth metallic restorations
in cross-sectional
may not be indicated for fine view
details in CBCT.
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 Patient-related artifacts
• Patient motion can cause faulty
registration of data, which appears
as unsharpness or double image in
the reconstructed image.
• If an object moves during the
scanning process, the reconstruction
process does not account for that
move . Faulty registration of
• Positive correlation is present with data due to patient
the amount of artifacts, reduced movement
quality images, and the presence of
restorations.

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 Scanner-related artifacts
• These artifacts typically present
as circular or concentric rings
centered on the location of the
axis of rotation.

• This is due to the malfunction in

the detector following faulty
calibration or imperfections in
scanner detection, which causes Image degradation due to full
a consistent and repetitive mouth metallic restorations.
reading at each angular position Image also shows:
1.pseudofracture and 2. ring
of the detector. artifact

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 Foreign objects
• The bite block may cast a shadow
as per its shape and size, which may
be confused as a foreign object.

• However, metal foreign objects

such as nose rings, earrings, clips,
etc. can cast a shadow as a result of
beam hardening.

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 Image Noise
• This is an important image deteriorating
factor.
• It is the result of inconsistent attenuation
values in the projection images .
• Most of the scattered radiation is produced in
all directions and is recorded as pixels by the
detector.
• This is different from the actual attenuation of
the object within a specific path of the X-ray
beam.
Noise
• Because of the use of an area detector, much
of this nonlinear attenuation is recorded and
contributes to image degradation seen as a
noise.
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 Poor Soft Tissue Contrast
• This drawback is the result of all other faults, mainly scatter
and noise.

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Methods to Reduce Drawbacks

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 CONCLUSION
• CBCT is a new imaging dimension of CT technology, which has
potential applications for imaging of high-contrast structures in
the dentomaxillofacial regions.

• When compared with medical CT, CBCT has increased accuracy,

higher resolution, reduced scan time, a reduction in radiation
dose, and reduced cost for the patient.

• When indicated, three-dimensional CBCT scans may supplement

conventional ‘two dimensional’ radiographic techniques, which
at present have higher resolution than CBCT images.
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 REFERENCES
• Textbook of Oral Radiology ; Anil Govindrao Ghom, Savita Anil Ghom ; 2 nd
Edition
• Essentials of Dental Radiography and Radiology ; Eric Whaites , Nicholas Drage ;
5th Edition.
• Essentials of Oral & Maxillofacial Radiology ;Freny R Karjodkar.
• Cone Beam Computed Tomography (CBCT): A New dimension of Imaging with
Basics and Clinical applications in Dentistry ; Akash Kumar Baranwal et al ;
International Journal of Maxillofacial Imaging, October-December,
2015;1(1):6-10
• The Genesis and Development of CBCT for Dentistry ; James Mah, DDS, DMSc,
MS, BSc.
• Image deteriorating factors in cone beam computed tomography, their
classification, and measures to reduce them: A pictorial essay ; Bhoosreddy AR
and Sakhavalkar PU ; Journal of Indian Academy of Oral Medicine &
Radiology | Jul-Sep 2014 | Vol 26 | Issue 3
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