RAFM: Retrieval-Augmented Flow Matching for Unpaired CBCT-to-CT Translation

Cone-beam computed tomography (CBCT) is widely used in image-guided radiotherapy, but scatter, beam hardening, noise, truncation, and other artifacts limit image quality and CT number accuracy. Paired CBCT and CT data are difficult to obtain clinically because of motion, anatomical changes, and acquisition mismatch. We present RefineCBCT, an unpaired CBCT refinement framework that uses pseudo-label guidance and short-step diffusion to reduce artifacts while preserving patient-specific anatomy. RefineCBCT was trained and evaluated on unpaired CBCT and planning CT data from public LUNG TCIA and PELVIC TCIA datasets and compared with representative GAN and diffusion based methods. On LUNG TCIA, it achieved the best results across all metrics, with MAE 19.411, RMSE 62.758, PSNR 30.845 dB, and SSIM 0.931. On PELVIC TCIA, it achieved the best MAE, PSNR, and SSIM, with values of 14.905, 36.671 dB, and 0.876. The refined images showed fewer streaking and shading artifacts, clearer anatomical boundaries, and improved soft tissue uniformity, with line profile and ROI analyses showing closer agreement with planning CT. These results suggest that RefineCBCT provides efficient and effective CBCT refinement under clinically realistic unpaired training conditions and may support more reliable CBCT use in image-guided radiotherapy workflows. Code is publicly available on GitHub, and the evaluated datasets are available from The Cancer Imaging Archive.

Deep generative models have recently emerged as powerful priors for solving ill-posed inverse problems in CT, with diffusion-based approaches achieving state-of-the-art reconstruction performance. However, diffusion models typically rely on stochastic sampling procedures, long inference trajectories, and carefully tuned noise schedules, which can limit computational efficiency and numerical stability, especially at high spatial resolutions. In this work, we investigate Flow Matching as an alternative generative prior for CT reconstruction. We train a high-resolution Rectified Flow Matching model on 256x256 chest images from the Mayo Clinic Low-Dose CT dataset. To mitigate overfitting and limited anatomical variability, we employ a two-stage training strategy consisting of an initial phase with strong, anatomically informed data augmentation, followed by a fine-tuning phase with reduced or no augmentation to refine structural fidelity. The resulting model is capable of generating high-quality and anatomically coherent CT-like images, serving as a strong learned prior. We then evaluate multiple reconstruction methods specifically designed for Flow Matching models, including Plug-and-Play Flow, FlowDPS, Flower, and Flow-Priors (ICTM), and compare them against state-of-the-art diffusion-based reconstruction algorithms such as DDRM, DPS, and DiffPIR. Experimental results across several CT inverse problem settings show that Flow Matching-based approaches consistently outperform diffusion-based methods in terms of PSNR, SSIM, and perceptual quality, while requiring fewer sampling steps. Finally, we publicly release the trained Flow Matching model and accompanying code to facilitate reproducibility and future research. Overall, this work demonstrates that Flow Matching provides a stable, efficient, and effective alternative to diffusion models for high-resolution CT image reconstruction.

Generative models, particularly Diffusion Models (DM), have shown strong potential for Computed Tomography (CT) reconstruction serving as expressive priors for solving ill-posed inverse problems. However, diffusion-based reconstruction relies on Stochastic Differential Equations (SDEs) for forward diffusion and reverse denoising, where such stochasticity can interfere with repeated data consistency corrections in CT reconstruction. Since CT reconstruction is often time-critical in clinical and interventional scenarios, improving reconstruction efficiency is essential. In contrast, Flow Matching (FM) models sampling as a deterministic Ordinary Differential Equation (ODE), yielding smooth trajectories without stochastic noise injection. This deterministic formulation is naturally compatible with repeated data consistency operations. Furthermore, we observe that FM-predicted velocity fields exhibit strong correlations across adjacent steps. Motivated by this, we propose an FM-based CT reconstruction framework (FMCT) and an efficient variant (EFMCT) that reuses previously predicted velocity fields over consecutive steps to substantially reduce the number of Neural network Function Evaluations (NFEs), thereby improving inference efficiency. We provide theoretical analysis showing that the error introduced by velocity reuse is bounded when combined with data consistency operations. Extensive experiments demonstrate that FMCT/EFMCT achieve competitive reconstruction quality while significantly improving computational efficiency compared with diffusion-based methods. The codebase is open-sourced at https://github.com/EFMCT/EFMCT.