IPv2: An Improved Image Purification Strategy for Real-World Ultra-Low-Dose Lung CT Denoising

Low-dose CT images are essential for reducing radiation exposure in cancer screening, pediatric imaging, and longitudinal monitoring protocols, but their quality is often degraded by noise from low-dose acquisition, patient motion, or scanner limitations, affecting both clinical interpretation and downstream analysis. Traditional filtering approaches often over-smooth and lose fine anatomical details, while deep learning methods, including CNNs, GANs, and transformers, may struggle to preserve such details or require large, computationally expensive models, limiting clinical practicality. We propose PatchDenoiser, a lightweight, energy-efficient multi-scale patch-based denoising framework. It decomposes denoising into local texture extraction and global context aggregation, fused via a spatially aware patch fusion strategy. This design enables effective noise suppression while preserving fine structural and anatomical details. PatchDenoiser is ultra-lightweight, with far fewer parameters and lower computational complexity than CNN, GAN, and transformer based denoisers. On the 2016 Mayo Low-Dose CT dataset, PatchDenoiser consistently outperforms state-of-the-art CNN- and GAN-based methods in PSNR and SSIM. It is robust to variations in slice thickness, reconstruction kernels, and HU windows, generalizes across scanners without fine-tuning, and reduces parameters by ~9x and energy consumption per inference by ~27x compared with conventional CNN denoisers. PatchDenoiser thus provides a practical, scalable, and computationally efficient solution for medical image denoising, balancing performance, robustness, and clinical deployability.

Propagation-based X-ray phase-contrast imaging (PBI) enables high-contrast visualization of lung structures and holds strong medical potential. However, safe translation to the clinic will require a substantial radiation dose reduction, which inevitably increases image noise. Supervised convolutional-neural-network-based denoising can restore image quality but depends on paired low- and high-dose datasets, which are rarely available in practice. Self-supervised methods avoid this limitation, yet most are not well adapted to the inverse problem of PBI computed tomography (CT). We introduce Neighbor2Inverse, a self-supervised denoising framework designed for low-dose PBI-CT that generalizes to clinical CT. Building on the Neighbor2Neighbor principle, each noisy projection is subsampled into two variants that preserve structural information but contain independent noise realizations. These are reconstructed separately, and the resulting pairs are used to train a denoising network directly in the image domain. We benchmark the proposed method against established analytical and self-supervised denoising approaches. In region-of-interest PBI CT experiments, Neighbor2Inverse achieves superior noise suppression while preserving fine structural details, as demonstrated by improved contrast-to-noise ratio, spatial resolution, and composite image quality metrics. Competitive performance is also observed on clinical CT data under simulated low-dose conditions. This work has been submitted to the IEEE for possible publication. Copyright may be transferred without notice, after which this version may no longer be accessible. Code, data, and interactive figures are available at https://github.com/J-3TO/Neighbor2Inverse.

Computed tomography (CT) plays a crucial role in medical diagnosis, but minimizing radiation exposure while maintaining image quality remains a critical challenge. Low-dose CT (LDCT) protocols reduce radiation risks but inevitably suffer from severe noise and artifacts that compromise diagnostic accuracy. While existing deep learning methods have achieved promising results, there remains a continuous quest for generative paradigms that intrinsically capture global-to-local structural dependencies to better preserve fine anatomical details. To this end, we propose DeVAR, a novel generative framework that applies visual autoregressive modeling (VAR) to LDCT denoising for the first time. Conditioned on global context provided by LDCT prefix tokens, DeVAR progressively generates discrete token maps of the target normal-dose CT (NDCT) via next-scale prediction. Because quantization inherently discards high-frequency information, we introduce a residual refiner to capture subtle anatomical structures beyond the capacity of a discrete codebook. Finally, empowered by a dual-representation hybrid training strategy, our hybrid NDCT decoder seamlessly integrates continuous and discrete latents to reconstruct high-fidelity, detail-preserved images. Extensive experiments on two public datasets demonstrate that DeVAR consistently achieves superior qualitative and quantitative performance compared to state-of-the-art LDCT denoising methods.