EUReCA: End-to-End Unified CBCT Reconstruction Across Clinical Acquisitions

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.

A long-term goal in CT imaging is to achieve fast and accurate 3D reconstruction from sparse-view projections, thereby reducing radiation exposure, lowering system cost, and enabling timely imaging in clinical workflows. Recent feed-forward approaches have shown strong potential toward this overarching goal, yet their results still suffer from artifacts and loss of fine details. In this work, we introduce Iterative Latent Volumes (ILV), a feed-forward framework that integrates data-driven priors with classical iterative reconstruction principles to overcome key limitations of prior feed-forward models in sparse-view CBCT reconstruction. At its core, ILV constructs an explicit 3D latent volume that is repeatedly updated by conditioning on multi-view X-ray features and the learned anatomical prior, enabling the recovery of fine structural details beyond the reach of prior feed-forward models. In addition, we develop and incorporate several key architectural components, including an X-ray feature volume, group cross-attention, efficient self-attention, and view-wise feature aggregation, that efficiently realize its core latent volume refinement concept. Extensive experiments on a large-scale dataset of approximately 14,000 CT volumes demonstrate that ILV significantly outperforms existing feed-forward and optimization-based methods in both reconstruction quality and speed. These results show that ILV enables fast and accurate sparse-view CBCT reconstruction suitable for clinical use. The project page is available at: https://sngryonglee.github.io/ILV/.

Cone beam computed tomography (CBCT) is widely used for image guided and adaptive radiotherapy, but scatter, noise, reconstruction artifacts, and inaccurate Hounsfield units limit its quantitative use. Recent diffusion approaches for CBCT to CT synthesis remain largely image driven, with limited use of the underlying acquisition physics. We propose EPC-RawDC, a conditional 3D latent diffusion framework that combines volumetric generative modeling with two complementary constraints derived from the same scanner specific CBCT forward model. First, geometry equivariant projection constraint exploits the rotational equivariance of the CBCT forward operator by supervising the synthesized CT through correspondingly transformed reference projections. Second, raw data consistency uses noisy projection measurements of the individual acquisition as scan specific supervision during training. The framework was evaluated on two independent clinical cohorts with distinct scanner geometries and projection sources. For JUST, the physics constraints used measured clinical raw CBCT projections acquired with an Elekta system, whereas for SynthRAD2025 the projection data were simulated from the reference CT using a Varian geometry with Poisson photon statistics. EPC-RawDC achieved an SSIM of 0.97 in both cohorts and improved PSNR over DDPM by 2.66 dB on SynthRAD2025 and 2.10 dB on JUST, while reducing mean MAE by 20.3% and 19.0%, respectively. On SynthRAD2025, projection consistency and equivariant errors were reduced by 55.0% and 41.4% relative to DDPM. These results demonstrate that combining a volumetric diffusion prior with scanner geometry and scan specific projection measurements improves quantitative CBCT to CT synthesis across both simulated and measured projection domains. Code available after publication at https://github.com/ALZAHRAALTALIB/EPC-RawDC.