Dual-Domain Sparse-View 4D CBCT Reconstruction with Spatial-Temporal Consistency Learning

Four-dimensional cone beam CT (4D CBCT) is important for image-guided radiation therapy of thoracic cancers, but its use is limited by long scan times, causing high patient dose and motion/sparse-sampling artifacts. We propose a deep learning method for motion-resolved 4D CBCT reconstruction from conventional free-breathing scans, without a respiratory signal or explicit projection binning. Our CNN takes free-breathing 3D CBCT projections as input and predicts a static volume at maximum inhalation plus ten displacement vector fields (DVFs) spanning a breathing cycle. The network extends U-Net: the encoder acts on filtered projection stacks, the decoder acts in the volume domain, and skip connections are replaced with non-trainable back-projection functions at multiple resolutions to transfer features between domains. The model is trained on simulated CBCT scans and evaluated on 11 unseen simulated patients and 13 clinical free-breathing scans. Two additional models (60 s and 6 s scans) were evaluated by clinical experts on three and two scans, comparing single phases of our 4D reconstruction to reference 3D SART-TV images for tumor and esophagus visibility. Experts preferred our method for tumor visibility (59% vs. 36% no preference, 5% reference) and esophagus visibility (47% vs. 42%, 11%). On simulated data, image quality matched SART-TV (mean RMSE: -1.19 HU, PSNR: +0.09 dB, SSIM: -0.009) while enabling 4D reconstruction. On clinical scans, our method showed sharper dynamic structures (e.g., diaphragm) and fewer motion streak artifacts than traditional reconstruction. This non-patient-specific CNN predicts static volumes and full 4D respiratory motion models from a single free-breathing scan, without a respiratory surrogate or projection binning, reducing motion artifacts while adding motion-modeling capability.

Sparse-view computed tomography (CT) reduces radiation dose and acquisition time but remains severely ill-posed because incomplete projections poorly constrain null-space information. Existing learning-based methods often estimate this information in high-dimensional image space, conflate physical measurement errors with prediction errors, and depend on fixed discretizations. We propose SONAR, a Structure-Consistent Neural Operator for Null-Space-Aware Reconstruction. Instead of recovering the full null-space component, SONAR predicts a low-dimensional null-space-aware representation from the acquired projections as pseudo-measurements. It separates measurement and pseudo-measurement residuals, lifts them into the image domain through physics operators, and applies independent neural operators to constrain their structural effects, thereby accommodating admissible errors while suppressing unsupported structures. To support cross-discretization reconstruction, an anisotropic U-shaped neural operator models the periodic angular and nonperiodic detector dimensions using direction-dependent continuous supports, while image-domain neural operators re-discretize continuous kernels on target grids. These components form an optimization-inspired unrolled network. Experiments on simulated AAPM and clinical MARS photon-counting CT data demonstrate consistent improvements across seen and unseen view settings and unseen image resolutions. On AAPM dataset, SONAR improves PSNR by 1.87dB at 62 views and by 7.63dB under zero-shot transfer to a $512\times512$ grid over the strongest competing methods. SONAR also achieves the best overall performance in all clinical settings evaluated, demonstrating accurate, structurally reliable, and discretization-robust sparse-view CT reconstruction.

Sparse-view cone-beam computed tomography (CBCT) is severely under-constrained by limited X-ray projections. Learned reconstruction can provide complementary anatomical information, but using it as a prior in patient-specific Gaussian reconstruction introduces two challenges. First, the discrepancy between the learned prior and current reconstruction is spatially non-uniform: some local differences contain useful missing 3D information, whereas others reflect prior bias. Second, even a volumetrically beneficial correction can conflict with the observed X-ray measurements. Since X-ray measurements are line integrals, spatially separated corrections may affect overlapping rays, with their signed projection responses reinforcing or partially canceling in the measurement residual, so their feasibility cannot always be assessed independently. In this paper, we introduce RePrior, a multi-stage progressive prior-correction framework that addresses correction actionability, measurement feasibility, and representation expressivity. Selective Correction Proposal (SCP) first identifies actionable signed local corrections from prior--reconstruction discrepancies. Measurement-Constrained Reconciliation (MCR) then jointly enforces their consistency with patient-specific X-ray measurements, while Hybrid Residual Enhancement (HRE) recovers additional correction capacity through complementary voxel- and Gaussian-domain degrees of freedom around the reconciled anchor. RePrior requires neither test-time ground truth nor case-specific network fine-tuning. RePrior gains approximately 2.6~dB in 3D PSNR over R$^2$-Gaussian across LUNA16, PANORAMA, and PENGWIN. Beyond prior-assisted reconstruction, it delivers additional gains in volumetric quality and observed-view projection fidelity, with consistent gains in held-out-view fidelity in the backbone-matched evaluation.