PET/CT Image Artifacts Caused by the Arms

PET/CT images are usually obtained in the arms-up position in patients with no head and neck pathology and in the arms-down position to image the head and neck area. The arms usually cause artifacts regardless of up or down positioning. These artifacts include beam hardening, scatter, truncation, and cold areas (cold artifacts) in obese or large patients; motion artifacts; implanted-metal-object artifacts; and artifacts related to radiotracer extravasation at the injection site. In this review article, we will discuss the mechanisms of these artifacts and suggest solutions to reduce or eliminate them, such as reviewing the non-attenuation-corrected PET images, performing extended-field-of-view reconstruction, not applying scatter correction, and using software to correct beam-hardening, scatter, and truncation artifacts. We will present various PET/CT images before and after corrections for such artifacts.