VoxelSynth3D: Interpretable Volumetric Image-Domain Metal Artifact Reduction with a Paired Synthetic CLINIC-Metal Benchmark

Computed tomography (CT) metal artifact reduction (MAR) aims to reduce the severe streaking artifacts induced by metallic implants and other high-density objects. Effective MAR generally requires both accurate artifact localization and artifact removal. Sinogram-domain methods can exploit explicit geometric cues, such as metal traces, to identify metal-corrupted measurements, while requiring raw projection data, which is often unavailable in clinical and practical scenarios. Image-domain methods are more flexible and widely applicable, yet they usually lack comparable geometric guidance, limiting their ability to localize artifacts and leading to suboptimal results. To address this limitation, we propose GraphMAR, a geometry-aware learning framework for explicit artifact identification and spatially adaptive MAR in the image domain. The key idea is to introduce graph-based geometric modeling as an image-domain analogue of sinogram metal traces. Specifically, we first construct a geometric graph from the metal mask and derive a geometric density graph that coarsely localizes artifact-prone regions according to inter-implant geometry. We then design GraphMoE, a graph-routed mixture-of-experts module that builds a polar-coordinate artifact graph in feature space and adaptively routes different experts to different spatial regions for MAR. By aligning the learned routing maps with the geometric density graph, GraphMAR provides explicit and interpretable artifact localization while enabling region-adaptive artifact reduction. Experiments on both simulated and real-world datasets demonstrate that GraphMAR achieves superior MAR performance compared with existing methods. To the best of our knowledge, this is the first work to introduce graph-based modeling for CT MAR and to enable explicit artifact identification in the image domain, improving both restoration quality and interpretability.

In X-ray CT, metallic objects cause beam hardening, photon starvation, and scattering, leading to projection inconsistency, streaks, dark bands, and structural distortions that compromise clinical diagnosis and quantitative analysis. Existing metal artifact reduction (MAR) methods remain limited: optimization-based methods may leave residual artifacts or blur structures, regression networks may generalize poorly across scenarios, and generative models without sample-specific structural guidance and physical constraints may produce anatomically inconsistent structures. Flow Matching learns a continuous-time velocity field that deterministically transports a source distribution to a target distribution, providing a flexible MAR prior. However, standard unconditional Flow Matching does not exploit sample-specific structure, spatially nonuniform metal-induced degradation, or measured projections. To address these limitations, we propose SCMA, a structure-conditioned and metal-aware Flow Matching framework. First, a linear-interpolation-corrected image is fed into the velocity network with the intermediate state as a sample-specific structural condition, guiding inference toward artifact-free CT images while preserving anatomy. Second, time-varying spatial weights from the metal mask and its distance transform are incorporated into the Flow Matching loss to emphasize severe degradation within and around metal regions. Finally, conditional Flow Matching updates alternate with projection-consistency correction during inference, allowing reliable measurements outside metal traces to constrain predictions. Experiments on simulated and real CT data demonstrate that SCMA more effectively suppresses metal artifacts, preserves local anatomical structures, and reduces hallucination-like structures inconsistent with projection measurements than representative MAR methods.

Cone-beam computed tomography (CBCT) enables volumetric reconstruction from X-ray projections, but suffers from severe artifacts--especially beam hardening--when imaging materials with high attenuation such as metals. These artifacts arise from the polychromatic nature of X-rays and are not properly addressed by conventional monochromatic reconstruction algorithms. While recent neural representation-based methods offer improved reconstruction quality, they are computationally expensive and often impractical for deployment. We propose a novel physics-inspired, self-calibrating metal artifact reduction method that efficiently reconstructs 3D CBCT volumes while correcting beam hardening artifacts. Our method integrates a polychromatic X-ray projection model, material-dependent attenuation profiles, and system response modeling into a Gaussian Splatting framework. Unlike prior work, we eliminate the need for manual metal masks or strong prior assumptions, and we optimize both reconstruction parameters and X-ray spectral characteristics jointly during training. We further introduce a high-fidelity synthetic CBCT dataset generation pipeline validated on Monte-Carlo x-ray simulation toolbox and release new datasets with severe metal-induced artifacts to support the community. This is the first splat-based method for reducing beam hardening in CBCT. Extensive experiments on both synthetic and real-world datasets demonstrate that our method outperforms state-of-the-art approaches in artifact suppression and reconstruction accuracy.