Three-Photon Bayesian Imaging of Ortho-Positronium

The introduction of LAFOV PET scanners brings significant sensitivity gains but also a substantial increase in the background rate from accidental coincidences, phantom-scattered and detector-scattered photons. While machine learning methods have been applied to background reduction in PET imaging, they target specific background components in post-processing rather than event-by-event classification on the raw data. In this work, we formulate coincidence classification as a supervised multi-class problem and evaluate XGBoost, AdaBoost and Neural Network classifiers as pre-reconstruction filters, using Monte Carlo simulations of the Siemens Biograph Vision Quadra scanner with NEMA IEC and anthropomorphic XCAT phantoms. We investigate two feature sets: a 4-feature representation based on the Attenuation Factor, photon time difference, energy sum, and energy difference, and an extended 6-feature set that incorporates topology-based variables. A systematic robustness study via cross-phantom inference reveals that the 4-feature models generalise significantly better across different phantom geometries, with XGBoost suffering an accuracy loss of only 0.04 compared to 0.13 for the 6-feature variant. Our best models achieve accuracies of up to 0.74 and 0.69 for the NEMA IEC and XCAT phantoms, respectively, outperforming traditional geometry-based cuts. However, we show that this compact feature set not only provides limited suppression of in-phantom scattered coincidences, but it also can lead to non-trivial spatial patterns. With scattered coincidences being the dominant background component in clinical conditions, this suggests that while the method serves as an effective and geometry-agnostic replacement for traditional cut-based selection, meaningful further gains in image quality will require either larger input representations or dedicated treatment of the phantom-scattered component.

Positron Emission Tomography (PET) image reconstruction is inherently challenged by Poisson noise and physical degradation factors, which are further exacerbated in limited-angle acquisitions. While deep learning methods demonstrate promising performance, their generalization to unseen clinical data distributions remains limited without extensive retraining. We propose PET-Adapter, a test-time domain adaptation framework for generative PET reconstruction models pretrained solely on phantom data. Our method enables adaptation to clinical datasets with varying anatomies, tracers, and scanner configurations without requiring paired ground truth. PET-Adapter introduces layer-wise low-rank anatomical conditioning during adaptation and Ordered Subset Expectation Maximization-based warm-starting that initializes the generation from physics-informed reconstructions, reducing diffusion steps from 50 to 2 without compromising quality. Experiments across multiple clinical datasets demonstrate superior 3D reconstruction performance in both full-angle and limited-angle settings, highlighting the clinical feasibility and computational efficiency of the proposed approach.

Reducing radiation exposure in Positron Emission Tomography (PET) is important for patient safety; however, ultra-low-dose imaging suffers from severe noise, which may affect diagnostic interpretation without appropriate image enhancement. While current 3D deep generative models, particularly diffusion models, have shown strong reconstruction fidelity, their practical use can be limited by long inference times. In contrast, faster 2D-based alternatives may have difficulty maintaining volumetric consistency, an important consideration for whole-body PET imaging analysis. To bridge this gap, we propose a one-pass conditional 3D rectified flow (3D Flow) framework for whole-body PET image denoising that incorporates a novel optimized non-uniform sampling strategy. The model is trained with a one-pass linear-interpolant velocity-matching objective. This approach reconstructs a full 3D volume in approximately 30 seconds in our implementation, compared with multi-hour inference for the evaluated 3D DDPM baseline. Evaluations including zero-shot transfer to an independent clinical dataset show that our model achieves favorable global image quality and lesion conspicuity compared with the evaluated 3D DDPM and DDIM baselines, including on challenging short-acquisition data. Furthermore, the proposed method shows promising zero-shot transfer performance across the evaluated datasets and unseen dose levels (down to 1/100 of the standard dose), with artifact-focused visual comparisons supporting the need for further lesion-level validation. By balancing reconstruction fidelity and computational efficiency, this work presents a candidate approach for ultra-low-dose whole-body PET image denoising.