FaCT-GS: Fast and Scalable CT Reconstruction with Gaussian Splatting

Photorealistic volume rendering of computed tomography (CT) may convey anatomy intuitively, but it needs the CT data, dedicated software and a powerful graphics processor. Three-dimensional Gaussian splatting (3DGS) displays photorealistic scenes in real time on less powerful devices, but existing medical approaches train each scene for minutes to hours. We aimed to convert a CT volume rendering directly into a 3DGS model without training. Splats were placed on an adaptive octree of millimetre-sized cells. Their colour and opacity were computed on the graphics processor with the renderer's lighting, cell opacity was converted analytically into splat opacity, and faint splats were retained stochastically above the 1/255 opacity floor of standard 3DGS rasterisers. Six public CT scans (1.5-mm voxels) were converted with three transfer functions and compared with converged references by peak signal-to-noise ratio (PSNR), structural similarity and a learned perceptual metric. Two-million-splat models reached a PSNR of 32.6 +/- 0.9 dB for bone, 30.1 +/- 1.0 dB for contrast-enhanced vessels and 32.3 +/- 1.5 dB for skin and bone. A conversion pass (usually two or three per model) took 4-30 s on a current laptop and 9-60 s on a desktop with a 4-GB graphics card. On the laptop, the models rendered at 68 frames per second at 800 x 800 pixels. Training-free conversion produced real-time 3DGS models of photorealistic CT renderings in about a minute or less per conversion pass on ordinary computers, with fidelity that we consider sufficient for interactive viewing.

Photorealistic volumetric rendering of CT scans greatly benefits clinical workflows, yet neural approaches such as Neural Radiance Fields (NeRF) and 3D Gaussian Splatting (3DGS) require prohibitive per-scan optimization (hours for NeRF, about 30 minutes for 3DGS), making them impractical in clinical settings. We propose Render-FM, a feedforward model that eliminates this bottleneck by directly regressing 6D Gaussian Splatting (6DGS) parameters from a CT volume in a single 2.8-second forward pass, a 500x speedup over per-scan optimization. To bridge the domain gap between natural scene reconstruction and medical volumetric rendering, we introduce Anatomy-Guided Priming (AGP), which incorporates segmentation masks and transfer functions as structural and appearance priors, information that existing Gaussian splatting methods overlook. Built on an nnU-Net-inspired 3D U-Net trained on diverse CT scans, Render-FM predicts per-voxel 6DGS parameters and supports immediate real-time rendering. Unlike per-scan methods, it generalizes to unseen anatomies, novel transfer functions, and enables compositional organ visualization with zero additional preparation time. Optional 89-second fine-tuning further improves quality, surpassing per-scan optimized baselines. Project page: https://gaozhongpai.github.io/renderfm/.

High-fidelity 3D medical visualization supports applications such as clinical assessment and surgical planning. Sparse-view computed tomography (CT) can reduce projection requirements and associated radiation exposure, but limited observations may introduce structural artifacts and reconstruction uncertainty. Although 3D Gaussian Splatting (3DGS) provides an efficient explicit representation for volumetric rendering, existing CT methods based on standard Gaussian primitives may be sensitive to unreliable observations under sparse-view acquisition. We present TR-GS, a Gaussian-splatting framework for sparse view CT volumetric rendering. TR-GS replaces standard Gaussian primitives with projectable Student's t-distribution primitives and introduces a ray-confidence model that regulates their degrees of freedom according to local ray observability. Confidence-guided 3D wavelet regularization is further used to balance high-frequency detail preservation and noise suppression. This work is licensed under a Creative Commons Attribution 4.0 International License. Experiments on synthetic and real-world datasets show that TR-GS improves over representative baselines in most evaluated settings and remains competitive in the remaining cases. The resulting volumetric representations may support downstream medical multimedia applications, including XR-based visualization and interactive clinical rendering.