Manual and Fully Automated Segmentation to Determine the Ferromagnetic Status of Bullets Using Computed Tomography Dual-Energy Index: A Phantom Study

Abstract

OBJECTIVE: The aim was to determine if dual-energy computed tomography (DECT) can discriminate ferromagnetic bullets from nonferromagnetic ones. METHODS: The ferromagnetic properties of 29 bullets were determined. All bullets underwent a DECT evaluation, and a manual measurement of the dual-energy index was performed by 2 radiologists, followed by a fully automatic measurement, in 3 different positions in a phantom (air, water, and bone). RESULTS: Twenty-one bullets were found to be nonferromagnetic. There were significant differences between the mean of the dual-energy index measured in the core of ferromagnetic projectiles and those of nonferromagnetic ones in the lung position of the phantom (P = 0.007). Specificity was 86.36%, and negative predictive value was 90.48%. Among the 29 bullets, 24 were correctly classified. CONCLUSIONS: Our study demonstrates that DECT can assess the ferromagnetic status of bullets and their magnetic resonance imaging compatibility using an extended computed tomography scale in an ex vivo phantom model.