Feed-Forward Hierarchical Gaussian Diffusion for Extreme CT Reconstruction

Reconstructing 3D Computed Tomography (CT) images from a few X-ray projections is a highly ill-posed inverse problem due to the loss of volumetric information. We propose PhyDiCT, a training-free framework that integrates a differentiable Physics-based forward model, grounded in the Beer-Lambert law, with a text-conditioned Diffusion as a strong prior to reconstruct 3D lung CT images. We refer to our approach as training-free since the prior model is used without fine-tuning, and our goal is to steer the denoising procedure to generate samples consistent with X-ray observations. We guide the diffusion generation using Split Gibbs sampling to jointly optimize for projection fidelity (reward) and consistency with prior knowledge. Also, we introduce a test-time refinement step that enhances image realism and anatomical coherence. We extensively evaluate our method on publicly available 3D CT datasets using both perceptual and semantic metrics, demonstrating that it surpasses existing plug-and-play diffusion and fully trained reconstruction approaches. Our findings highlight that combining a strong generative prior with the underlying physics of image formation substantially improves reconstruction quality, e.g., 7.5% improvement on SSIM compared to full training methods. Code will be released at https://github.com/batmanlab/PhyDiCT.

Computed tomography (CT) throughput is limited by scan time, which grows with both the number of projections acquired and the detector integration time for each projection. Reconstructing high-quality volumes from sparse-view or low-dose measurements therefore depends on using an informative prior, typically a neural network trained for one specific scan setting and retrained whenever the modality, geometry, or material changes. We investigate whether a single diffusion model trained across several imaging domains can instead serve as a reusable prior for heterogeneous CT reconstruction problems. We evaluate the proposed method using the same diffusion visual transformer model and normalized denoising strength on three datasets that differ in modality, beam geometry, material, and degradation type, spanning additively manufactured metal parts and concrete microstructure imaged with cone-bean X-ray CT and parallel-beam neutron CT respectively. The proposed method improves upon analytic reconstructions in all three cases, demonstrating transferability across the evaluated problems and providing a step toward a reusable foundation prior for heterogeneous CT reconstruction.

Sparse-view computed tomography (CT) reduces radiation dose and acquisition time and may mitigate motion artifacts. However, angular undersampling provides insufficient information to determine the image uniquely and stably. Limited-angle CT, arising from restricted angular coverage, produces strongly directional information loss associated with the missing angular range. In both settings, image directions may be strongly observed, weakly constrained, or unobservable, leading to severe ill-posedness and reconstruction ambiguity. Existing diffusion-based approaches incorporate measurement information through likelihood guidance, data-consistency operations, or range-null-space corrections. However, they do not generally use the continuously varying measurement sensitivity of the acquisition to jointly shape both reconstruction updates and stochastic exploration. We propose a geometry-aware diffusion-guided stochastic reconstruction framework for sparse-view and limited-angle CT. Its central component is a regularized noise-weighted pullback metric constructed from the CT forward operator and measurement-noise covariance. This metric continuously adapts both the measurement-aware update and stochastic exploration according to directional measurement sensitivity, suppressing changes along strongly constrained directions while permitting greater exploration along weakly constrained and unobservable directions. We complement this geometry-aware update with a regularized data-consistency correction and approximately null-space-restricted stochastic perturbations, implemented matrix-free using forward and backprojection operations together with conjugate-gradient solves. Experiments on sparse-view, noisy, and limited-angle CT demonstrate competitive reconstruction quality, strong measurement consistency, and spatially resolved empirical uncertainty estimates.