PSCT-Net: Geometry-Aware Pediatric Skull CT Reconstruction via Differentiable Back-Projection and Attention-Guided Refinement

Panoramic radiograph (PR) is fundamentally used in routine dental care, but it inherently provides only a two-dimensional (2D) projection of complex three-dimensional (3D) craniofacial anatomy. Most existing learning-based methods attempt to computationally recover this 3D information by directly regressing native cone-beam computed tomography (CBCT) volumes from PR. However, this direct mapping requires the model to simultaneously learn common anatomical structures and patient-specific morphological variations. This entangled formulation makes the ill-posed 2D-to-3D inverse problem highly ambiguous, often producing over-smoothed reconstructions with blurred anatomical boundaries. To address this, we propose HyDAR-Pano3D, a two-stage framework that reformulates PR-to-CBCT reconstruction as a disentangled anatomical recovery problem. In Stage 1, a dual-encoder network integrates radiographic features with SAM-derived semantic priors to reconstruct an arch-normalized canonical volume. In Stage 2, an Anatomical Restoration Network predicts a prior-constrained structured deformation field to map this canonical volume back to the native space, restoring individual morphological variations. Experiments on three large-scale datasets show that HyDAR-Pano3D significantly outperforms baseline methods ($p < 0.05$), achieving a 25.76 dB PSNR, 85.70% SSIM, and an 83.83% overall anatomical Dice score. The synthesized volumes successfully support downstream segmentation of whole teeth (82.4% Dice) and the inferior alveolar canal (72.2% Dice), demonstrating that our disentangled approach preserves clinically relevant structures to enable robust anatomy-aware assessment when CBCT data is unavailable.

Computed tomography (CT) provides rich 3D anatomical detail but is often constrained by high radiation exposure, substantial costs, and limited availability. Standard chest X-rays are cost-effective and widely accessible, but provide only 2D projections with limited pathological information. Reconstructing 3D CT volumes from 2D X-rays could markedly increase diagnostic accessibility, yet existing methods rely predominantly on synthetic X-ray projections, limiting clinical generalization. We propose AXON, a multi-stage diffusion-based framework that reconstructs 3D CT volumes directly from real X-rays with substantially improved fidelity over existing approaches. AXON follows a coarse-to-fine paradigm: a Brownian Bridge diffusion model first captures global anatomical structure, and a ControlNet-guided refinement stage then enhances local intensity detail and anatomical realism. To alleviate the depth ambiguity inherent in 2D-to-3D reconstruction, AXON incorporates bi-planar X-ray views, enabling more accurate spatial reasoning and structural recovery. A dedicated super-resolution module further increases the spatial resolution of the generated volumes. Experiments on public and external datasets show that AXON consistently surpasses state-of-the-art approaches while generalizing across diverse clinical distributions. At our highest-resolution bi-planar setting, AXON achieves an 11.9% improvement in PSNR and an 11.0% increase in SSIM over the strongest baseline evaluated at that resolution. In the $128^3$ single-planar setting, it maintains a lead of 7.8% in PSNR on LIDC-IDRI, with larger margins on the external clinical dataset of 8.0% in PSNR and 16.9% in SSIM. Our code is available at https://github.com/ai-med/AXON/.

Generating a 3D dental volume from a single panoramic radiograph (PXR) could provide a low-radiation alternative to Cone-Beam Computed Tomography (CBCT), but the problem is highly underdetermined: panoramic acquisition integrates 3D attenuation along curved X-ray paths into a 2D image, leaving depth-resolved anatomy unobserved. Existing implicit and generative approaches often produce oversmoothed geometry or anatomically inconsistent hallucinations, lacking geometry-driven supervision and relying on smooth representations unable to precisely localize sharp anatomical boundaries. We propose X-Splat, the first Gaussian Splatting framework for generating CBCT-like 3D dental volumes from a single PXR. X-Splat uses the known panoramic acquisition geometry as a generation scaffold: learnable anisotropic Gaussian primitives are initialized along the X-ray paths that formed the input image and adjusted in a single feed-forward pass, constrained by Beer-Lambert reprojection and multi-view radiographic training supervision. A lightweight residual refiner adds dataset-level anatomical priors without overriding the geometry already resolved by the Gaussians. We train on synthetic PXR-CBCT pairs, enabling direct volumetric supervision without paired real scans. We further introduce segmentation-based geometry-aware metrics, providing the first evaluation of PXR-based generation over maxillofacial anatomy. X-Splat outperforms NeRF- and GAN-based baselines, recovering individual teeth, cortical boundaries, and alveolar structure, including the mandibular canal which prior methods fail to reconstruct. Code will be available at https://github.com/tomek1911/X-Splat