Common artifacts in computerized
tomography: A review
Issa Al-Shakhrah, PhD and Tariq Al-Obaidi, PhD
A
computed tomographic (CT)
image is a display of the
anatomy of a thin slice of the
body developed from multiple X-ray
absorption measurements made around
the body’s periphery. Unlike conven-
tional tomography, in which the image
of a thin slice is created by blurring out
the information from unwanted
regions, the CT image is constructed
mathematically, using data arising only
from the section of interest. Generating
such an image is confined to cross sec-
tions of the anatomy that are oriented
essentially perpendicular to the axial
dimension of the body.1
An artifact is any distortion or error
in an image that is unrelated to the sub-
ject being studied. Artifacts are rela-
tively common in CT imaging and may
be considered as a source, or type, of
noise. Their cause may not always be
obvious. However, there are a number
of different effects that may be respon-
sible for artifacts in CT.
Because artifacts in CT arise as a
result of the interaction between the
subject and the machine, it is useful to
classify the artifacts by the nature of
the error made in the scanning process.
In CT, artifacts may be produced by:
Dr. Al-Shakhrah is an Associate Professor
of Medical Physics, University of Jordan,
Amman, Jordan; and Dr. Al-Obaidi is
a Professor of Medical Physics, Mu’tah
University, Al-Karak, Jordan.
August 2003
• Errors in X-ray attenuation measurements;
• Alterations in the energy spectrum of
the X-ray beam (beam hardening) as
it passes through the patient;
• The presence of high-density foreign
materials in the body;
• Partial-volume averaging effect;
• Motion of the patient;
• Quantum mottle (noise);
• Malfunction of the detector arising
from errors in detector calibrations
and balance, geometric effects, or a
machine peculiarity; or
• Inadequate temperature, humidity, or
the presence of small dust particles
within the computer that causes an inad-
equacy in the reconstruction algorithm.
This article will present common arti-
facts such as streaks, rings, and black
and white bands that appear in CT stud-
ies. This review addresses causes of arti-
facts, their effects on the quality of the
radiographic image, and procedures that
can be used to reduce the presence of
such artifacts. The reduction of artifacts
enhances CT interpretive accuracy and
helps to establish a correct diagnosis.
Method
During a 1-year period, 7197 CT stud-
ies were performed in a large (600-bed)
teaching hospital. Within this total num-
ber of studies, 432 repeat studies were
performed due to image artifacts. These
repeat studies were collected and classi-
fied according to the cause of the artifacts
viewed. The study included both inpa-
www.appliedradiology.com
tients and outpatients, but not all CT
studies of uncooperative patients from
intensive and coronary care units were
repeated. The CT systems employed in
this study included a Siemens Somotom
Plus 4 spiral CT (Siemens Medical Solu-
tions, Erlangen, Germany) and a Philips
Tomoscan AV spiral CT (Philips Med-
ical Systems, Best, Netherlands).
Results
Repeat CT studies were performed
due to artifacts in 432 patients, and repeat
CT studies were obtained in 6% of all CT
studies performed during the review
period. Major artifacts were found in the
form of streaks, rings, and black and
white bands. Figures 1 through 8 provide
examples of artifacts on CT scans in dif-
ferent regions and organs in which arti-
facts can clearly be seen. Figure 9
presents the causes of artifacts as well as
the incidence of each artifact found in the
images studied. Regardless of cause,
most CT artifacts found in the study were
manifest as streaks in the CT image.
Discussion
Joseph2 has reported two reasons for
streak artifacts. First, each individual
measurement involves the evaluation
of a single ray or straight-line path
through the slice. A second, more sub-
tle cause for streak artifacts arises
when there is an abrupt discrepancy or
inconsistency between views, as might
be seen with patient motion.
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COMMON CT ARTIFACTS
A B
C D
FIGURE 1. CT artifacts caused by motion.
(A) and (B) Black or white bands and dark
spots appear on brain CT scans. (C) Loss of
resolution appears on sinus CT (coronal view).
(D) Distortion of anatomy appears on brain CT.
FIGURE 2. Black and white
bands and blurring artifacts
on lung CT were produced
by inaccurate X-ray tube
geometry.
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The following discussion will
address our results and their causes,
according to each artifact etiology.
Motion
Patient motion has a devastating
effect on image quality. This was the pri-
mary reason for the development of a
body unit (spiral CT) that could com-
plete a scan during a patient’s breath-
hold.
The artifacts found in our study
caused by motion were manifested as
black or white bands, dark spots, loss
of resolution, or distortion of anatomy3
(Figure 1). These artifacts account for
15% of repeated studies. Clinically,
such artifacts are important not only
because they degrade image quality,
but also because they can sometimes
be mistaken for pathologic changes,
such as bronchiectasis.4
Theoretically, motion artifacts can
be reduced by fast scanning,5 gating,6
tube alignment,7 corrective reconstruc-
tion,8 or postprocessing of the scan.9
Knowing the pattern, magnitude,
and frequency of motion in advance
would allow the use of an algorithm to
remove the motion from the projection
data and then reconstruct a motion-free
or, at least, a motion-reduced image.10
A technical problem is image mis-
registration due to variation in breath-
holding from one scan to the next.11
Misregistration leads to failure to
image part of the lung, such that a
lesion might be partially or entirely
excluded on the final scan. This prob-
lem is eliminated by using spiral CT
during breath-holding.12,13
X-ray geometry, geometric oversights
Precise control of fan-beam position
is important for the production of high-
quality CT images; failure to maintain
fan-beam orientation can produce image
artifacts.14 Performance of CT systems
relies mainly on geometric precision and
measurement quality. Inaccurate geome-
try, inaccurate alignment of the X-ray
tube with the detectors, or incorrect data
can produce artifacts and blurring that
limit spatial resolution (Figure 2). In our
August 2003
 COMMON CT ARTIFACTS

FIGURE 3. Ring artifact appears on brain CT caused by inaccurate FIGURE 4. Multiple artifacts due to misalignment of X-ray tube and
matching and inaccurate intercalibration of the detectors. detectors, foreign heavy metal on the film, and beam hardening
(posterior fossa near the petrous bones).

study, artifacts due to geometric causes
accounted for 5% of repeat studies. A
precise geometric calibration proce-
dure is required, and some corrections
must be applied to the raw attenuation
data in order to obtain accurate mea-
surements. An X-ray cone-beam CT
system has been developed by Rizo
and Martin.15 The machine was
designed to control small parts limited
to a few centimeters, with a high spa-
tial resolution close to 30 microns.
They introduced the machine setup and
described the calibration computing
resources involved in the system. They
also discussed the performance on
experimental data.15
Detector artifacts
Artifacts from errors in detector cal-
ibrations and balance are common. A
malfunction of any one detector would
incorrectly backproject along the data
ring to produce the artifacts. If detec-
tors are not matched or intercalibrated
accurately, the backprojection for each
data ring would be slightly different,
causing multiple rings (Figure 3).
These artifacts caused by equipment
malfunction can be eliminated by
repair or good preventive maintenance.
Beam hardening
Beam-hardening artifacts result from
the preferential absorption of low-
energy photons from the beam. The
effect is more pronounced in areas of
large attenuation, such as bone. The
artifact is seen as a shadow beneath ribs,
for example, or increased shadows in
the mediastinum or skull (Figure 4).
This type of artifact accounted for 21%
of the repeat scans in our study. This
effect occurs throughout the image but
usually is not perceived except where
there is a great deal of hardening, such
as in the vicinity of bone. This effect can
be compensated for by the use of special
filters or a special correction algorithm.1
Recent experiments using CT and
transmission radiography show that
gadolinium (Gd) agents can increase
image contrast by up to a factor of 2
when compared with more commonly
used iodinated agents on an equi-molar
basis. It has also been suggested that
beam-hardening artifacts may be re-
duced with the use of Gd. This hypothe-
sis was tested by Ruth and Joseph16 on
three different CT scanners using a circu-
lar water equivalent phantom with a con-
trast-filled tube inserted. It was found
that the artifacts were 1.3 to 1.8 times
more pronounced with the iodinated con-
trast when compared with gadopentetate
dimeglumine (Gd-DTPA).
High-density foreign material
The presence of objects that have an
exceptionally high or low attenuation
can create streaking artifacts by forcing
the detectors to operate in a nonlinear
response region.1 Figure 5 demonstrates
the star pattern caused by high-density
foreign materials. In our study, this type
of artifact caused 25% of repeat studies,
one of the most common reasons for
image degradation. A small metal frag-
ment produces a star pattern, and the star
effect is accentuated by any motion. The
only way to avoid this problem with cur-
rent mathematical reconstructions is to
change the angle of the slice to exclude
the foreign body, but this approach
might also exclude pathology. A similar
pattern can be produced by gas, for
example, in the gastric fundus, but the
effect is less marked.4
Partial-volume averaging
When tissues of widely different
absorption occupy the same voxel, the
beam attenuation is proportional to the
average value of the attenuation

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COMMON CT ARTIFACTS

A B C

D E F

FIGURE 5. CT heavy streaks or star artifacts. Metallic fillings in teeth, (A) axial view and (B) coronal view. (C) Metallic filling in a tooth appears
on a CT of the sinuses (coronal view). (D) Metallic stent in the heart appears on a chest CT. (E) Surgical clips (prosthesis) in the common intra-
hepatic bile duct appear on abdominal CT. (F) Surgical clips around the intracavernous part of the left internal carotid artery appear on brain CT.

A B C

FIGURE 6. (A through C) The skull appears thicker on successively more cephalad scans, because the orientation of the bone becomes more
oblique and less perpendicular to the scan section (partial-volume averaging effect).

coefficient of the voxel. A volume aver-
age is computed for such voxels, leading
to the partial-volume error. The scan of
the skull-brain shown in Figure 6
demonstrates this effect. Images gener-
ated with helical scanning are degraded
by partial-volume artifacts caused by an
increased slice thickness when com-
pared with conventional CT scanning.18
Partial-volume effects on measurements
of CT numbers may be minimized by
the use of thin sections and by the selec-
tion of a section that lies in the center of
the object of interest for measurement.19
Quantum mottle (noise) artifacts
In a study of 20 examiniations, soft-
tissue imaging degraded by scattering
artifacts was reported in 14 examina-
tions.20 Quantum mottle is dose-related
image noise that has the appearance
of granular steaks arising from high-

28 ■ APPLIED RADIOLOGY ©
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 COMMON CT ARTIFACTS

A B

FIGURE 7. Effects of quantum mottle. (A) Heavy black and white bands appear on pituitary gland (coronal view). (B) Foggy pelvis CT.

B attenuation structures, such as the shoulder

A
region. A generalized adaptive median fil-
ter (GAMF) was introduced by Hsieh21 for
more robust noise suppression and edge
preservation in CT to combat severe
streaking artifacts resulting from excessive
X-ray quantum noise (Figure 7).

Temperature and humidity

Some computer components are more
sensitive to extremes of temperature and
humidity than is conventional X-ray
equipment. For this reason, manufac-
turer’s recommendations regarding air
conditioner installation should be
FIGURE 8. (A) and (B) Black and white bands and less resolution appear on two different closely followed. Whenever possible, a
slices of brain CT due to malfunction of the CT computer caused by inadequate temperature
regulation in the computer room.
backup air-conditioning system should
be available. The low-temperature limits
below which solid-state devices cannot
operate appropriately will probably
never be encountered in a hospital
installation. Failure from moderately
increased temperature, as well as
humidity, will frequently take the form
of unexplained malfunctions of the com-
puter,19 including increasing numbers of
artifacts and inappropriate responses to
instructions (Figure 8).
One aspect of the computer environ-
ment that must be considered is dust par-
ticle size. The particle size of cigarette
smoke is only slightly larger than the
size of the air gap between the playback
head and disk drive of the computer sys-
tem. In addition, its relatively small size
FIGURE 9. Classification of the repeated studies (artifacts) according to the following causes, makes it particularly difficult to filter
from left to right: motion; X-ray geometry, geometric oversights; detectors; beam hardening; from the atmosphere. For this reason,
high-density foreign materials; partial-volume averaging; quantum mottle (noise); and tempera- smoking in the computer room should
ture and humidity. be strictly forbidden.

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COMMON CT ARTIFACTS
Conclusion
In our study, CT artifacts were found
to be produced by: the presence of high-
density foreign materials in the body
(25%); an error in X-ray attenuation
measurements, as a result of alterations
in the energy spectrum of the X-ray
beam (beam hardening) as it passes
through the patient (21%); partial-
volume–averaging effects (16%);
motion of the patient (15%); quantum
mottle (noise) (7%); malfunction of the
detector arising from errors in detector
calibrations and balance (6%); geomet-
ric effects or a machine peculiarity (5%);
and by inadequate temperature, humid-
ity, or the presence of small dust parti-
cles within the computer causing an
inaccuracy in the reconstruction algo-
rithm (5%). Regardless of the causes of
the artifacts found in this study, most CT
artifacts manifested as streaks. Films
that were repeated due to artifacts
accounted for 6% of the total 7197 films
taken during the 1-year period. Patient
cooperation, use of thin sections, repair
and/or good preventive maintenance, a
clean computer environment, and suit-
able temperature and humidity can
reduce artifacts to a minimum. AR
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Acknowledgment
The authors thank Mr. Jameel Al-
Sarayrah for his assistance in collect-
ing CT studies and in classifying
imaging artifacts according to etiology.
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