Cone-Beam CT

Cone-beam CT (CBCT) is routinely acquired during radiotherapy for patient setup, but its quantitative reliability is degraded by scatter, noise, and reconstruction artifacts, limiting Hounsfield Unit (HU) accuracy. We propose EPC-3D-Diff, a novel conditional 3D latent diffusion framework for volumetric CBCT to CT synthesis that introduces a projection domain equivariance loss derived from acquisition physics. Unlike common image domain equivariance, we exploit the fact that an in plane rotation of the volume corresponds to an angular shift in its projections. During training, we enforce this relationship by forward projecting rotated synthesized CT volumes and matching them to appropriately angle shifted projections of the paired target CT, yielding a physics consistent equivariance constraint integrated into the diffusion objective. To capture full 3D context efficiently, conditional diffusion is performed in a compact latent space learnt by a lightweight 3D autoencoder, preserving axial depth while downsampling in plane resolution for stable training. We validate on a paired head CBCT/CT phantom dataset, including repeat scans, and paired clinical data using patient wise splits, and perform single and mixed domain training, ablations, and comparisons with diffusion and CycleGAN. EPC-3D-Diff generalizes well and achieved substantial improvements, +7.4 dB (phantom) and +1.8 dB (clinical data) in PSNR compared to state of the art methods, alongside improved SSIM and HU accuracy, within tissue boundaries. Overall, EPC-3D-Diff improves robustness and physics consistency, supporting HU aware synthesis for downstream radiotherapy workflows. The open source code for EPC-3D-Diff is available at https://github.com/ALZAHRAALTALIB/EPC-3D-Diff.

Radiation therapy (RT) requires precise dose delivery over multiple fractions, with CT fundamental for treatment planning due to its electron density information. Repeated CT acquisitions impose radiation exposure and logistical burdens, MRI lacks electron density, and cone-beam CT (CBCT) requires correction for dose calculation. Synthetic CT (sCT) generation addresses these by converting MRI or CBCT into CT-equivalent images with accurate Hounsfield Unit (HU) values, enabling MRI-only RT and CBCT-based adaptive workflows. Building on SynthRAD2023, SynthRAD2025 benchmarked sCT methods on 2,362 patients from five European centers across head and neck, thorax, and abdomen. Two tasks: MRI-to-CT (890 cases) and CBCT-to-CT (1,472 cases), evaluated via image similarity (MAE, PSNR, MS-SSIM), segmentation (Dice, HD95), and dosimetric metrics from photon and proton plans. With 803 participants and 12/13 valid submissions, Task 1 top performance reached MAE $64.8\pm21.3$ HU, PSNR $\sim$30 dB, MS-SSIM $\sim$0.936, Dice 0.79, photon $γ_{2\%/2\text{mm}}>98\%$, proton $γ\approx85\%$. Task 2 improved: MAE $48.3\pm13.4$ HU, PSNR 32.6 dB, MS-SSIM 0.968, Dice 0.86, photon $γ>99\%$, proton $γ\approx89\%$. Strong image--segmentation correlations ($ρ=0.78$--$0.79$) but moderate dose correlations confirmed image quality is insufficient as a dosimetric surrogate. Head-and-neck cases were most consistent; thoracic and abdominal cases showed greater variability. Residual errors at tissue interfaces propagate along beam paths, affecting proton dose more than photon. SynthRAD2025 demonstrates that deep learning yields clinically relevant sCTs, especially for CBCT-to-CT, while identifying persistent MRI-to-CT challenges and underscoring dose-based evaluation as essential for clinical validation.

Cone Beam Computed Tomography (CBCT) is pivotal for 3D diagnostic imaging in dentistry. However, the development of robust AI models for volumetric analysis is often constrained by the scarcity of large, annotated datasets. Self-supervised learning (SSL), particularly Masked Image Modeling (MIM), offers a promising pathway to leverage unlabeled data. A limitation of standard MIM is its reliance on random masking, which fails to prioritize diagnostically critical regions in dental CBCT volumes, such as subtle pathological changes and intricate anatomical boundaries. To address this, we propose ATMask, a novel adaptive masking strategy. Instead of applying random masks or employing computationally intensive attention modules, ATMask computes an inter-slice texture variation map to identify regions with high structural or textural complexity. These high-variation areas are then selectively masked during pre-training, compelling the model to learn richer contextual representations essential for inferring complex 3D morphological transitions. Furthermore, we contribute the first large-scale CBCT dataset, curated from both public and private sources, comprising 6,314 scans, for the dental AI model pretraining. Extensive experiments on three downstream dental CBCT tasks demonstrate that our ATMask enables more data-efficient and powerful representation learning than standard random masking and other advanced SSL baselines. The dataset and code will be released.

While 3D Gaussian splatting (3DGS) offers explicit and efficient scene representations for cone-beam computed tomography reconstruction, conventional photometric optimization inherently suffers from spectral bias under ultra sparse-view conditions, leading to over-smoothing and a loss of high-frequency anatomical details. Since wavelet transforms provide rich high-frequency information and have been widely utilized to enhance sparse reconstruction, this work integrates wavelet multi-resolution analysis with 3DGS. To circumvent the mathematical mismatch between the strict non-negativity of physical X-ray attenuation and the bipolar nature of high-frequency wavelet coefficients, we propose Residual Gaussian Splatting (RGS). Methodologically, we introduce a spectrally-decoupled Gaussian representation that stratifies the volumetric field into a geometric base component and a residual detail component. This decomposition systematically transforms explicit high-frequency fitting into a physically consistent, implicit residual compensation task. Furthermore, we devise a spectral-spatial collaborative optimization strategy to coordinate the interplay between geometric anchoring and texture refinement, effectively preventing spectral crosstalk. Extensive experiments on clinical datasets demonstrate that RGS enables the reconstructed images to capture highly refined geometric textures. It successfully resolves the trade-off between artifact suppression and detail preservation, yielding superior visual fidelity in complex trabecular and vascular structures compared to existing neural rendering baselines.

Computed Tomography (CT) is a widely used imaging modality in medical and industrial applications. To limit radiation exposure and measurement time, there is a growing interest in sparse-view CT, where the number of projection views is significantly reduced. Deep neural networks have shown great promise in improving reconstruction quality in sparse-view CT, especially generative diffusion models. However, these methods struggle to scale to large 3D volumes due to several reasons: (i) the high memory and computational requirements of 3D models, (ii) the lack of large 3D training datasets, and (iii) the inconsistencies across slices when using 2D models independently on each slice. We overcome these limitations and scale diffusion-based sparse-view CT reconstruction to large 3D volumes by combining conditional diffusion with explicit data consistency. We propose Conditional Diffusion Posterior Alignment (CDPA) to enable scalable 3D sparse-view CT reconstruction. A 2D U-Net diffusion model is conditioned on an initial 3D reconstruction to improve inter-slice consistency, combined with data-consistency alignment to match measured projections. Experiments on synthetic and real Cone Beam CT (CBCT) data show state-of-the-art performance, with ablations that confirm the synergistic effects of the proposed pipeline. Finally, we show that the same principles also strengthen fast denoising U-Nets, yielding near-diffusion quality at a fraction of the computational cost.

Iterative reconstruction technique's ability to reduce radiation exposure by using fewer projections has attracted significant attention. However, these methods typically require a precise tuning of several hyperparameters, which can have a major impact on reconstruction quality. Manually setting these parameters is time-consuming and increases the workload for human operators. In this paper, we introduce a novel fully automatic parameter optimization framework that can be applied to a wide range of Cone-beam computed tomography (CBCT) iterative reconstruction algorithms to determine optimal parameters without requiring a reference reconstruction. The proposed method incorporates a modified crow search algorithm (CSA) featuring a superior set-dependent local search mechanism, a search-space-aware global search strategy, and an objective-driven balance between local and global search. Additionally, to ensure an effective initial population, we propose a chaotic diagonal linear uniform initialization scheme that accelerates algorithm convergence. The performance of the proposed framework was evaluated on three imaging machines and four real datasets, as well as three different iterative reconstruction methods with the highest number of tunable parameters, representing the most challenging senario. The results indicate that the proposed method could outperform manual settings and CSA, with an 4.19% improvement in average fitness and 4.89% and 3.82% improvements on CHILL@UK and RPI_AXIS, respectively, which are two benchmark no-reference learning-based quality metrics. In addition, the qualitative results clearly show the superiority of the proposed method by maintaining fine details sharply. The overall performance of the proposed framework across different comparison scenarios demonstrates its effectiveness and robustness across all cases.

Accurate 3D dental imaging is vital for diagnosis and treatment planning, yet CBCT's high radiation dose and cost limit its accessibility. Reconstructing 3D volumes from a single low-dose panoramic X-ray is a promising alternative but remains challenging due to geometric inconsistencies and limited accuracy. We propose HiCT, a two-stage framework that first generates geometrically consistent multi-view projections from a single panoramic image using a video diffusion model, and then reconstructs high-fidelity CBCT from the projections using a ray-based dynamic attention network and an X-ray sampling strategy. To support this, we built XCT, a large-scale dataset combining public CBCT data with 500 paired PX-CBCT cases. Extensive experiments show that HiCT achieves state-of-the-art performance, delivering accurate and geometrically consistent reconstructions for clinical use.

Cone-beam computed tomography (CBCT) images are problematic in clinical medicine because of their low contrast and high artifact content compared with conventional CT images. Although there are some studies to improve image quality, in regions subject to organ deformation, the anatomical structure may change after such image quality improvement. In this study, we propose an overcorrection-free CBCT image quality enhancement method based on a conditional latent diffusion model using pseudo-CBCT images. Pseudo-CBCT images are created from CT images using a simple method that simulates CBCT artifacts and are spatially consistent with the CT images. By performing self-supervised learning with these spatially consistent paired images, we can improve image quality while maintaining anatomical structures. Furthermore, extending the framework of the conditional diffusion model to latent space improves the efficiency of image processing. Our model was trained on pelvic CT-pseudo-CBCT paired data and was applied to both pseudo-CBCT and real CBCT data. The experimental results using data of 75 cases show that with our proposed method, the structural changes were less than 1/1000th (in terms of the number of pixels) of those of a conventional method involving learning with real images, and the correlation coefficient between the CT value distributions of the generated and reference images was 0.916, approaching the same level as conventional methods. We also confirmed that the proposed framework achieves faster processing and superior improvement performance compared with the framework of a conditional diffusion model, even under constrained training settings.

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/.

With the rapid advancement of artificial intelligence, intelligent dentistry for clinical diagnosis and treatment has become increasingly promising. As the primary clinical dentistry task, tooth structure segmentation for Cone-Beam Computed Tomography (CBCT) has made significant progress in recent years. However, challenges arise from the obtainment difficulty of full-annotated data, and the acquisition variability of multi-source data across different institutions, which have caused low-quality utilization, voxel-level inconsistency, and domain-specific disparity in CBCT slices. Thus, the rational and efficient utilization of multi-source and unlabeled data represents a pivotal problem. In this paper, we propose SemiTooth, a generalizable semi-supervised framework for multi-source tooth segmentation. Specifically, we first compile MS3Toothset, Multi-Source Semi-Supervised Tooth DataSet for clinical dental CBCT, which contains data from three sources with different-level annotations. Then, we design a multi-teacher and multi-student framework, i.e., SemiTooth, which promotes semi-supervised learning for multi-source data. SemiTooth employs distinct student networks that learn from unlabeled data with different sources, supervised by its respective teachers. Furthermore, a Stricter Weighted-Confidence Constraint is introduced for multiple teachers to improve the multi-source accuracy.Extensive experiments are conducted on MS3Toothset to verify the feasibility and superiority of the SemiTooth framework, which achieves SOTA performance on the semi-supervised and multi-source tooth segmentation scenario.

Generative AI has advanced rapidly in medical report generation; however, its application to oral and maxillofacial CBCT reporting remains limited, largely because of the scarcity of high-quality paired CBCT-report data and the intrinsic complexity of volumetric CBCT interpretation. To address this, we introduce CBCTRepD, a bilingual oral and maxillofacial CBCT report-generation system designed for integration into routine radiologist-AI co-authoring workflows. We curated a large-scale, high-quality paired CBCT-report dataset comprising approximately 7,408 studies, covering 55 oral disease entities across diverse acquisition settings, and used it to develop the system. We further established a clinically grounded, multi-level evaluation framework that assesses both direct AI-generated drafts and radiologist-edited collaboration reports using automatic metrics together with radiologist- and clinician-centered evaluation. Using this framework, we show that CBCTRepD achieves superior report-generation performance and produces drafts with writing quality and standardization comparable to those of intermediate radiologists. More importantly, in radiologist-AI collaboration, CBCTRepD provides consistent and clinically meaningful benefits across experience levels: it helps novice radiologists improve toward intermediate-level reporting, enables intermediate radiologists to approach senior-level performance, and even assists senior radiologists by reducing omission-related errors, including clinically important missed lesions. By improving report structure, reducing omissions, and promoting attention to co-existing lesions across anatomical regions, CBCTRepD shows strong and reliable potential as a practical assistant for real-world CBCT reporting across multi-level care settings.

Intraoperative Cone Beam Computed Tomography (CBCT) provides a reliable 3D anatomical context essential for interventional planning. However, its static nature fails to provide continuous monitoring of soft-tissue deformations induced by respiration, probe pressure, and surgical manipulation, leading to navigation discrepancies. We propose a deformation-aware CBCT updating framework that leverages robotic ultrasound as a dynamic proxy to infer tissue motion and update static CBCT slices in real time. Starting from calibration-initialized alignment with linear correlation of linear combination (LC2)-based rigid refinement, our method establishes accurate multimodal correspondence. To capture intraoperative dynamics, we introduce the ultrasound correlation UNet (USCorUNet), a lightweight network trained with optical flow-guided supervision to learn deformation-aware correlation representations, enabling accurate, real-time dense deformation field estimation from ultrasound streams. The inferred deformation is spatially regularized and transferred to the CBCT reference to produce deformation-consistent visualizations without repeated radiation exposure. We validate the proposed approach through deformation estimation and ultrasound-guided CBCT updating experiments. Results demonstrate real-time end-to-end CBCT slice updating and physically plausible deformation estimation, enabling dynamic refinement of static CBCT guidance during robotic ultrasound-assisted interventions. The source code is publicly available at https://github.com/anonymous-codebase/us-cbct-demo.

In interventional radiology, Cone-Beam Computed Tomography (CBCT) is a helpful imaging modality that provides guidance to practicians during minimally invasive procedures. CBCT differs from traditional Computed Tomography (CT) due to its limited reconstructed field of view, specific artefacts, and the intra-arterial administration of contrast medium. While CT benefits from abundant publicly available annotated datasets, interventional CBCT data remain scarce and largely unannotated, with existing datasets focused primarily on radiotherapy applications. To address this limitation, we leverage a proprietary collection of unannotated interventional CBCT scans in conjunction with annotated CT data, employing domain adaptation techniques to bridge the modality gap and enhance liver segmentation performance on CBCT. We propose a novel unsupervised domain adaptation (UDA) framework based on the formalism of Margin Disparity Discrepancy (MDD), which improves target domain performance through a reformulation of the original MDD optimization framework. Experimental results on CT and CBCT datasets for liver segmentation demonstrate that our method achieves state-of-the-art performance in UDA, as well as in the few-shot setting.

Cone-beam computed tomography (CBCT) is a widely used 3D imaging technique in dentistry, offering high-resolution images while minimising radiation exposure for patients. However, CBCT is highly susceptible to artefacts arising from high-density objects such as dental implants, which can compromise image quality and diagnostic accuracy. To reduce artefacts, implant inpainting in the sequence of projections plays a crucial role in many artefact reduction approaches. Recently, diffusion models have achieved state-of-the-art results in image generation and have widely been applied to image inpainting tasks. However, to our knowledge, existing diffusion-based methods for implant inpainting operate on independent 2D projections. This approach neglects the correlations among individual projections, resulting in inconsistencies in the reconstructed images. To address this, we propose a 3D dental implant inpainting approach based on perpendicular score-based diffusion models, each trained in two different planes and operating in the projection domain. The 3D distribution of the projection series is modelled by combining the two 2D score-based diffusion models in the sampling scheme. Our results demonstrate the method's effectiveness in producing high-quality, artefact-reduced 3D CBCT images, making it a promising solution for improving clinical imaging.

Cone-beam CT (CBCT) is routinely acquired in radiotherapy but suffers from severe artifacts and unreliable Hounsfield Unit (HU) values, limiting its direct use for dose calculation. Synthetic CT (sCT) generation from CBCT is therefore an important task, yet paired CBCT--CT data are often unavailable or unreliable due to temporal gaps, anatomical variation, and registration errors. In this work, we introduce rectified flow (RF) into unpaired CBCT-to-CT translation in medical imaging. Although RF is theoretically compatible with unpaired learning through distribution-level coupling and deterministic transport, its practical effectiveness under small medical datasets and limited batch sizes remains underexplored. Direct application with random or batch-local pseudo pairing can produce unstable supervision due to semantically mismatched endpoint samples. To address this challenge, we propose Retrieval-Augmented Flow Matching (RAFM), which adapts RF to the medical setting by constructing retrieval-guided pseudo pairs using a frozen DINOv3 encoder and a global CT memory bank. This strategy improves empirical coupling quality and stabilizes unpaired flow-based training. Experiments on SynthRAD2023 under a strict subject-level true-unpaired protocol show that RAFM outperforms existing methods across FID, MAE, SSIM, PSNR, and SegScore. The code is available at https://github.com/HiLab-git/RAFM.git.

Cone-beam computed tomography (CBCT) is widely used in dental and maxillofacial imaging, but low-dose acquisition introduces strong, spatially varying noise that degrades soft-tissue visibility and obscures fine anatomical structures. Classical denoising methods struggle to suppress noise in CBCT while preserving edges. Although deep learning-based approaches offer high-fidelity restoration, their use in CBCT denoising is limited by the scarcity of high-resolution CBCT data for supervised training. To address this research gap, we propose a novel Hybrid Attention Residual U-Net (HARU-Net) for high-quality denoising of CBCT data, trained on a cadaver dataset of human hemimandibles acquired using a high-resolution protocol of the 3D Accuitomo 170 (J. Morita, Kyoto, Japan) CBCT system. The novel contribution of this approach is the integration of three complementary architectural components: (i) a hybrid attention transformer block (HAB) embedded within each skip connection to selectively emphasize salient anatomical features, (ii) a residual hybrid attention transformer group (RHAG) at the bottleneck to strengthen global contextual modeling and long-range feature interactions, and (iii) residual learning convolutional blocks to facilitate deeper, more stable feature extraction throughout the network. HARU-Net consistently outperforms state-of-the-art (SOTA) methods including SwinIR and Uformer, achieving the highest PSNR (37.52 dB), highest SSIM (0.9557), and lowest GMSD (0.1084). This effective and clinically reliable CBCT denoising is achieved at a computational cost significantly lower than that of the SOTA methods, offering a practical advancement toward improving diagnostic quality in low-dose CBCT imaging.

Undersampled CT volumes minimize acquisition time and radiation exposure but introduce artifacts degrading image quality and diagnostic utility. Reducing these artifacts is critical for high-quality imaging. We propose a computationally efficient hybrid deep-learning framework that combines the strengths of 2D and 3D models. First, a 2D U-Net operates on individual slices of undersampled CT volumes to extract feature maps. These slice-wise feature maps are then stacked across the volume and used as input to a 3D decoder, which utilizes contextual information across slices to predict an artifact-free 3D CT volume. The proposed two-stage approach balances the computational efficiency of 2D processing with the volumetric consistency provided by 3D modeling. The results show substantial improvements in inter-slice consistency in coronal and sagittal direction with low computational overhead. This hybrid framework presents a robust and efficient solution for high-quality 3D CT image post-processing. The code of this project can be found on github: https://github.com/J-3TO/2D-3DCNN_sparseview/.