Task-Based CT Protocol Optimization Using Reinforcement Learning and Virtual Imaging Trials

Computed Tomography (CT) is indispensable in clinical diagnostics, yet minimizing radiation dose without compromising image quality remains a critical challenge. Conventional low-dose protocols often rely on fixed, uniform angular sampling, independent of the underlying structural complexity of organs of individual patients. We propose ``Stochastic Adaptive Variance-Driven Exploration and Reconstruction'' (SAVER), an adaptive data acquisition framework that selects projection angles in real-time based on the statistical variance of acquired data. Utilizing a Softmax-based stochastic scheduling scheme with simulated annealing, SAVER prioritizes directions with high structural information while maintaining necessary exploration. Numerical experiments across 8 diverse phantoms demonstrate that SAVER achieves consistently higher reconstruction fidelity than conventional random sampling, particularly for objects with high structural anisotropy. Furthermore, the proposed method exhibits robust performance under significant measurement noise. By dynamically reallocating radiation dose to the most informative projections, SAVER provides a mathematically-grounded approach to maximize diagnostic quality per unit of radiation dose, marking a shift toward sample-dependent, data-driven CT acquisition.

Comparing CT reconstruction methods fairly is labor-intensive and largely manual, and many benchmarks use idealized data. We ask whether a large language model (LLM) agent can do the labor of reconstruction research on its own, and whether a ranking measured on ideal data predicts behavior under realistic noise. We built an agentic loop: the agent edits a solver, runs a short cluster job, reads one frozen metric, and revises. The metric is a calibrated headroom score against the FBP baseline, inside the field of view; every method shares the same differentiable fan-beam projector. We benchmarked 26 methods on Mayo low-dose CT (noise-limited) and a 128-view sparse-view breast task from the noiseless DL-Sparse-View Challenge, with validation-selected iterations scored on a held-out test set. Every trained breast model was then re-scored on noisy inputs (I_0 = 10^5 photons) without retraining, and separately retrained on matched noise. The agent independently implemented, tuned, and benchmarked all 26 methods, and recombined them into a compact solver of 969 parameters that ties the top Mayo tier at the 1% level using 0.4% of the champion's parameters. Benchmarking gives a tier of statistically indistinguishable top methods, not one winner. Mild input noise nearly inverts the breast ranking: the noiseless champion (a supervised image denoiser, hr 0.89) collapses to 0.00, while a learned primal-dual method rises to champion (0.72 to 0.93). An ideal-data leaderboard therefore does not predict robustness. The inversion is a transfer effect, not a permanent deficit: retraining on matched noise restores much of the clean ranking (Spearman rho 0.04 to 0.61). Noise is only the easiest confounder in an open-ended set (beam hardening, scatter, anatomy, disease), so no single-factor challenge certifies generality. Benchmarks should model a broad spectrum of realistic factors at once.

The use of CT imaging is important for screening, diagnosis, therapy planning, and prognosis of lung cancers. Unfortunately, due to differences in imaging protocols and scanner models, CT images acquired by different means may show large differences in noise statistics, contrast, and texture. In this study, we develop a novel conditional MeanFlow pipeline for CT image reconstruction. We introduce a conditional MeanFlow network that models the enhancement trajectory by predicting image-conditioned flow fields given intermediate image states. The image enhancement network is trained with a MeanFlow consistency loss along with the image reconstruction loss. In order to provide an adaptive refinement process in terms of spatial location of enhancements, we integrate a regional reinforcement learning-driven policy network into our approach. The policy network receives information about the MeanFlow rollouts and provides predictions in terms of tile-wise refinement budgets, stopping criteria, and total budget allocation of enhancement processes. Our policy network is trained through reinforcement learning in a policy gradient framework, where the goal of the training reward is to maximize improvement of enhancements while minimizing unnecessary computations and avoiding instabilities. In this way, our approach combines conditional flow-based enhancement with reinforcement learning-based spatial enhancement control. This allows our approach to focus more attention on enhancing difficult areas while stabilizing areas already showing sufficient quality. Our results show high accuracy in the tumor ROI, with the average radiomic feature CCC being 0.96, an average PSNR of 31.30 $\pm$ 4.16, and average SSIM of 0.94 $\pm$ 0.07. Moreover, there is an improvement in the overall quality of images, with an average PSNR of 34.23 $\pm$ 1.71 and average SSIM of 0.95 $\pm$ 0.01.