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Original research
Motion artifact correction for cone beam CT stroke imaging: a prospective series
  1. Nicole M Cancelliere1,2,3,
  2. Fred van Nijnatten4,
  3. Eric Hummel4,
  4. Paul Withagen4,
  5. Peter van de Haar4,
  6. Hidehisa Nishi2,
  7. Ronit Agid5,
  8. Patrick Nicholson5,
  9. Bertan Hallacoglu4,
  10. Marijke van Vlimmeren4,
  11. Vitor M Pereira1,2,3
  1. 1 Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
  2. 2 RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
  3. 3 Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
  4. 4 Image Guided Therapy, Philips Healthcare, Best, Noord-Brabant, The Netherlands
  5. 5 Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Nicole M Cancelliere, Department of Neurosurgery, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, M5B 1T8, Canada; nicole.cancelliere{at}


Background Imaging assessment for acute ischemic stroke (AIS) patients in the angiosuite using cone beam CT (CBCT) has created increased interest since endovascular treatment became the first line therapy for proximal vessel occlusions. One of the main challenges of CBCT imaging in AIS patients is degraded image quality due to motion artifacts. This study aims to evaluate the prevalence of motion artifacts in CBCT stroke imaging and the effectiveness of a novel motion artifact correction algorithm for image quality improvement.

Methods Patients presenting with acute stroke symptoms and considered for endovascular treatment were included in the study. CBCT scans were performed using the angiosuite X-ray system. All CBCT scans were post-processed using a motion artifact correction algorithm. Motion artifacts were scored before and after processing using a 4-point scale.

Results We prospectively included 310 CBCT scans from acute stroke patients. 51% (n=159/310) of scans had motion artifacts, with 24% being moderate to severe. The post-processing algorithm improved motion artifacts in 91% of scans with motion (n=144/159), restoring clinical diagnostic capability in 34%. Overall, 76% of the scans were sufficient for clinical decision-making before correction, which improved to 93% (n=289/310) after post-processing with our algorithm.

Conclusions Our results demonstrate that CBCT motion artifacts are significantly reduced using a novel post-processing algorithm, which improved brain CBCT image quality and diagnostic assessment for stroke. This is an important step on the road towards a direct-to-angio approach for endovascular thrombectomy (EVT) treatment.

  • Angiography
  • Brain
  • Stroke
  • Subarachnoid

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors All authors substantially contributed to the manuscript. VMP and NMC designed the work; NMC and VMP drafted the original manuscript; and all authors were involved in data acquisition, interpretation of data for the work, critical revision for important intellectual content, final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. VMP is the guarantor of the study.

  • Funding This research was supported by a Master Research Agreement between Philips and Toronto Western Hospital.

  • Competing interests FvN, PvdH, EH, MvV, PW and BH are employed by Philips. This research was supported by a Master Research Agreement between Philips and Toronto Western Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.