Cone-Beam Computed Tomography

Dental cone-beam computed tomography (CBCT) systems often employ detector configurations that provide a truncated field of view (FOV) that only captures a small part of the patient's anatomy. In this work, we aim to reconstruct an extended FOV using projections of truncated FOV scans. To this end, we propose a three-stage framework that consists of (1) an implicit neural representation (INR) for estimating missing parts of the truncated projection data, (2) an iterative reconstruction for generating a secondary volumetric image with improved anatomical consistency and (3) a fast diffusion model for image enhancement. The proposed approach combines the strengths of continuous representations, physics-based reconstruction and generative refinement within a unified pipeline for truncated CBCT imaging. Experimental results demonstrate that the method effectively reduces truncation artifacts, improves the reconstruction of structures extending beyond the original FOV and produces images with enhanced quality. Our code is publicly available at https://github.com/SusanneSchaub/CBCT-FOV-Extension.

Malocclusion skeletal grading is a fundamental task in orthodontics, critical for diagnosis and treatment planning. Traditionally, cone-beam computed tomography (CBCT) is used for visual measurement, and the reconstructed lateral cephalograms are handed over to expert dentists for diagnosis. However, manual review is time-consuming, labor-intensive, and subject to inter-operator variability. Therefore, an automatic CBCT-based system is needed for reliable malocclusion skeletal grading. In this case, we develop TeethGNN, a novel graph-based framework designed to combine CBCT image features with morphological information for accurate and efficient malocclusion grading. TeethGNN utilizes a decoupled learnable decoder to directly predict key morphological indicators from CBCT images, eliminating the need for manual measurements. These morphological features are then fused with image features using a graph neural network (GNN), which effectively models the relationships between the modalities. To further enhance robustness and calibration, we introduce a collaborative calibration strategy. This strategy combines multi-scale graph adversarial perturbation for explicit calibration and nonlinear topological graph calibration for implicit confidence adjustment. Extensive experiments and ablation studies on our collected clinical dataset demonstrate that our malocclusion measurement system achieves 77.08% in accuracy and 89.61% in AUC, outperforming the compared state-of-the-art methods. These results validate the effectiveness of graph-based multimodal fusion and collaborative calibration in improving malocclusion grading performance. Our system shows strong potential for advancing computer-aided orthodontic diagnosis, providing an accurate and reliable solution for vision-based clinical measurement and diagnosis.

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.

During standard radiotherapy planning, repeated CT acquisitions are often required for patient registration, verification, and adaptive planning, resulting in increased cumulative X-ray dose. To mitigate this, low-dose cone-beam CT (CBCT) is routinely acquired during treatment delivery. However, CBCT image quality remains insufficient for accurate dose calculation and adaptive radiotherapy planning due to increased scatter, noise, beam hardening, and reconstruction related artifacts. This study develops a supervised deep learning based CBCT to CT synthesis framework using a conditional denoising diffusion probabilistic model (DDPM), where the generation of a CT-based planning for accurate positioning and dose calculation is obtained using generative models with low dose CBCT imaging. Beyond demonstrating CBCT to CT synthesis, the primary objective is to investigate how the representation of CBCT input data, either standard clinical DICOM CBCT images or filtered back-projection (FDK) reconstructions from raw projection data, affects the performance of diffusion based CT synthesis. The overarching aim is to assess whether physics aware CBCT representations better support CT-equivalent image quality while maintaining reduced imaging dose in radiotherapy workflows.

Registration between cone-beam computed tomography (CBCT) and intraoral scans (IOS) is essential for patient-specific surgical planning. However, disparate imaging modalities, limited overlap, and large pose offsets make automated registration unreliable. Consequently, clinical registration remains dependent on conventional geometry pipelines and manual clinician adjustment. To address these challenges, we propose APCReg, an anatomical-prior-guided coarse-to-fine framework for global registration and reliability-controlled residual correction. Specifically, multi-view anatomical coarse registration (MACR) performs ordered orthogonal projection alignment (buccal, proximal, and occlusal) to decompose the six-degree-of-freedom search before three-dimensional refinement. Overlap-aware residual registration (OARR) combines shared KPConv features, a folded arch-length cue, overlap-gated cross-attention, and Sinkhorn matching. Finally, dental-arch-structured hypothesis selection evaluates diverse poses on held-out reliable correspondences, while a ground-truth-free coarse-retention guard conditionally retains a geometrically reliable coarse pose. On 60 held-out jaw pairs, APCReg achieves a submillimeter mean Chamfer distance of 0.87 mm and a Hausdorff distance of 2.92 mm under this evaluation protocol, and ranks first across the six reported metrics among the evaluated open-source baselines.

Mandibular reconstruction restores facial continuity and oral function after segmental resection. Patient-specific cutting guides transfer a computed tomography (CT)-based plan to the operating room with three-dimensional information, but printed guides add cost and lead time, cannot adapt after fabrication, and may interrupt surgery if sterility is lost. We investigate a markerless augmented reality (AR) alternative that registers a virtual cutting guide to the exposed mandible from surface geometry. The method extends surface-based registration for the transoral setting, where teeth form the most distinctive visible surface. After camera calibration, a HoloLens 2 time-of-flight camera captures a partial intraoperative point cloud. The user supplies a rough head-based alignment only to crop the region of interest. A teeth-weighted global stage computes correspondences and solves a truncated least-squares rigid alignment. An asymmetric point-to-plane iterative closest point (ICP) stage refines the complete CT mandible against the partial depth cloud target. The guide-to-mandible transform places the guide in the HoloLens world frame, while pose updates and interpolation follow target motion. We define a blinded phantom protocol with 30 target registration error (TRE) points under full, intermediate, and teeth-only exposure, plus a motion-to-display latency test. Our median TRE is 4.05, 6.10, and 7.10 mm respectively, and median latency is 0.805 s. These values support the feasibility of using AR to replace physical prints. The workflow removes mounted fiducials and manual landmark selection and provides a testable path toward transoral cutting guidance.

X-ray computed tomography (CT) suffers from severe metal artifacts when high-attenuation objects such as dental fillings or orthopedic implants are present. These artifacts originate from the polychromatic nature of X-rays, where attenuation varies strongly with photon energy and material composition, breaking the monochromatic assumption used by conventional reconstruction algorithms. Recent neural rendering approaches attempt to address this mismatch through differentiable polychromatic projection models, but they still struggle with smoothness bias, loss of fine structures, and prohibitive computation when extended to large-scale cone-beam CT. We introduce a splat-based metal artifact reduction framework that incorporates a physically grounded polychromatic forward model into a continuous Gaussian representation for cone-beam CT. Each Gaussian encodes the energy-dependent attenuation of the underlying material using a compact material parameterization, which enables efficient joint optimization of geometric and material properties without relying on a metal mask. This compact attenuation formulation captures the essential variation across biological tissues and metallic implants, allowing our model to explain metal-induced nonlinearity while preserving high-frequency structure. Experiments on simulated and real cone-beam CT scans show that our method converges significantly faster and suppresses metal artifacts more effectively than existing reconstruction and neural field-based approaches.

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.

Medical image quality plays a critical role in diagnostic accuracy, especially in X-ray-based imaging modalities such as cone-beam computed tomography (CBCT), where image quality must be balanced against radiation dose. While expert visual evaluation remains the clinical standard for image quality evaluation, it is time-consuming, subjective and affected by inter-observer variability, emphasizing the need for reliable quantitative image quality assessment (IQA) methods. However, the development and validation of such IQA methods have been limited by the lack of publicly available CBCT datasets with expert image quality annotations. In this study, we provide the first open-access CBCT IQA dataset containing 1,764 annotated image slices acquired using systematic variations in image acquisition and reconstruction parameters. Three clinical experts graded the overall image quality and a predefined regions of interest (ROI) using a four-level scoring scheme. In addition, we benchmark 26 full reference- and no reference-based IQA measures against expert annotations and introduce an exploratory IQA measure-based ranking capable of distinguishing subtle image quality differences. This dataset introduced a standardized benchmark for future CBCT IQA research and provides a valuable resource for the development and validation of new IQA methods, enabling reproducible research and advancing CBCT IQA.

Metal artifacts generated by dental implants significantly degrade cone-beam computed tomography (CBCT) volumes, obscuring critical anatomical structures and compromising diagnostic precision. To address this, an unsupervised deep learning framework has been proposed for Metal Artifact Reduction (MAR) utilizing a Cycle-Consistent Adversarial Network (CycleGAN) optimized for high-fidelity restoration. Unlike supervised methods that rely on unattainable voxel-aligned paired datasets, the proposed approach leverages an unpaired dataset of approximately 4,000 images, curated from the public ToothFairy dataset. The architecture integrates U-Net-based generators and PatchGAN discriminators, specifically tuned to mitigate generative hallucinations and preserve morphological integrity. Quantitative benchmarking on a held-out test set demonstrates a 34.6% improvement in the Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE) score, a substantial reduction in Fréchet Inception Distance (FID) from 207.03 to 157.04, and a superior Structural Similarity Index Measure (SSIM) of 0.9105. The framework achieves real-time efficiency with a 3.03 ms inference time per slice, effectively suppressing artifacts while preserving anatomical detail. Expert validation confirms high fidelity; however, to ensure reliability in extreme cases, the architecture is recommended as a clinical decision-support tool under human-in-the-loop oversight. By enhancing diagnostic clarity via a scalable software pipeline, this study provides a robust solution for high-fidelity dental implant imaging.

The differentiable shift-variant filtered backprojection (SV-FBP) framework enables data-driven estimation of redundancy weights for cone-beam CT reconstruction under general source trajectories, removing the need for analytically derived weighting schemes. In this work, we present a systematic study of the robustness and adaptability of differentiable SV-FBP under challenging acquisition settings. We show that the framework remains stable across highly irregular and discontinuous trajectories, indicating that reconstruction performance is largely insensitive to trajectory ordering or continuity. Instead, the spatial distribution of sampling points plays a more dominant role. Under sparse-view conditions, differentiable SV-FBP achieves competitive reconstruction quality while providing an order-of-magnitude reduction in computation time compared to iterative reconstruction methods at moderate sampling densities. However, we identify a clear transition regime under severe undersampling, where the absence of iterative data consistency leads to performance degradation. Furthermore, we demonstrate that the framework remains applicable to non-planar multi-isocenter geometries, such as Lissajous-saddle trajectories, without requiring architectural modifications. These findings provide new insights into the behavior and limitations of the differentiable SV-FBP model and highlight it as a flexible and efficient solution for non-standard and robotic CBCT acquisition scenarios.

Mobile C-arm cone-beam computed tomography (CBCT) has been widely used for real-time intraoperative 3D imaging. However, current practice often mechanically applies the fan-beam CT criterion of "180° plus fan angle" in pursuit of "data completeness" in reconstruction. This review argues that, under the single circular trajectory of three-dimensional cone-beam geometry, complete data are mathematically unattainable; moreover, blindly increasing sampling may exacerbate the trade-off among intraoperative image quality (Q), imaging time (T), and radiation dose (D). Against this background, this review reframes the evaluation of intraoperative CBCT around "data sufficiency" rather than "data completeness." This perspective moves beyond the excessive pursuit of absolute mathematical and analytic accuracy, and instead emphasizes task-specific minimum image-quality thresholds required for clinical decision-making. By synthesizing evidence from multiple clinical scenarios, this review suggests that approximation errors can be acceptable when clinical decision-making requirements are satisfied, thereby achieving a Q-T-D balance.

Generating a 3D dental volume from a single panoramic radiograph (PXR) could provide a low-radiation alternative to Cone-Beam Computed Tomography (CBCT), but the problem is highly underdetermined: panoramic acquisition integrates 3D attenuation along curved X-ray paths into a 2D image, leaving depth-resolved anatomy unobserved. Existing implicit and generative approaches often produce oversmoothed geometry or anatomically inconsistent hallucinations, lacking geometry-driven supervision and relying on smooth representations unable to precisely localize sharp anatomical boundaries. We propose X-Splat, the first Gaussian Splatting framework for generating CBCT-like 3D dental volumes from a single PXR. X-Splat uses the known panoramic acquisition geometry as a generation scaffold: learnable anisotropic Gaussian primitives are initialized along the X-ray paths that formed the input image and adjusted in a single feed-forward pass, constrained by Beer-Lambert reprojection and multi-view radiographic training supervision. A lightweight residual refiner adds dataset-level anatomical priors without overriding the geometry already resolved by the Gaussians. We train on synthetic PXR-CBCT pairs, enabling direct volumetric supervision without paired real scans. We further introduce segmentation-based geometry-aware metrics, providing the first evaluation of PXR-based generation over maxillofacial anatomy. X-Splat outperforms NeRF- and GAN-based baselines, recovering individual teeth, cortical boundaries, and alveolar structure, including the mandibular canal which prior methods fail to reconstruct. Code will be available at https://github.com/tomek1911/X-Splat

A synthetic measurement of model competence is useful only if it survives the move to real data, yet the real labels that would verify it are exactly what medical imaging lacks. We ask whether transfer can be predicted in advance, label-free, and answer with a mechanism: on synthetic digital twins, competence that is donor-driven (a property of the transplanted nodule) survives the synthetic to real change of host, while host-driven competence (a property of the surrounding anatomy) need not. We test this on three lung CT vision-language tasks chosen to span that axis, across five public VLMs, four guidance conditions, and seven real datasets. The prediction holds in every case: presence and size orderings transfer (R2 >= 0.96), lobe does not; the split survives leave-source-out calibration, and the diagnostic names that boundary before any real label. TrialCouncil, a training-free council calibrated only on synthetic CT, confirms it by matching the best fixed model exactly where transfer is predicted. The contribution is not the router but the finding that transfer itself is predictable, label-free, from synthetic data alone.

Temporomandibular joint osteoarthritis (TMJ OA) is a prevalent degenerative condition whose osseous changes are often subtle on cone-beam CT (CBCT), making automated detection challenging. We study how well the DINO family of self-supervised vision transformers -- DINOv1, DINOv2, DINOv2+reg, and RAD-DINO (a radiology-pretrained variant) -- transfers to CBCT, asking how much backbone adaptation is needed and of what kind. We propose a simple slice-based pipeline using Vision Transformer (ViT) backbones: axial CBCT slices are encoded per-slice by a frozen or partially adapted ViT and aggregated via attention-based multiple instance learning (MIL) for patient-level binary OA/Normal classification. Through systematic ablation across unfreezing strategies and aggregation designs on a multi-source CBCT dataset, we find that partial unfreezing of the final two transformer blocks is the decisive factor, improving AUC from 0.671 (fully frozen DINOv2) to 0.902. This outperforms DINOv1 (0.867), DINOv2+reg (0.774), and a supervised ImageNet ViT-B/16 baseline (0.843). Our results provide practical guidance for adapting DINO-family foundation models in low-data medical imaging settings, showing that adaptation strategy is a stronger driver of performance than backbone choice alone.

Cone-beam computed tomography (CBCT) frequently suffers from data truncation, which introduces severe artifacts and limits the effective field of view (FOV). Existing deep learning methods for truncated cone-beam computed tomography (CBCT) reconstruction suffer from serious limitations, including a strict reliance on supervised ground truth and a failure to account for continuous 3D spatial truncation variations. To address these challenges, we introduce a self-supervised 3D reconstruction framework based on neural scene representations. By directly mapping spatial coordinates to radiodensity under projection supervision, our approach inherently bypasses traditional filtering and backprojection operations, thereby fundamentally eliminating truncation-induced ring artifacts while enabling robust continuous 3D data extrapolation. However, coordinate networks are susceptible to an inherent spectral bias, which leads to a severe loss of clinically vital high-frequency textures. To resolve this bottleneck, we further incorporate a physics-based iterative refinement module into the neural scene representation architecture. Leveraging the artifact-free, extrapolated volume from the coordinate network as an optimal initialization, this module progressively re-extracts and injects high-frequency structural information from the original projections back into the volume. Extensive experiments on both simulated and real-world datasets demonstrate that our method successfully unifies the exceptional artifact suppression and extrapolation capabilities of neural networks with the high-fidelity detail preservation of iterative algorithms.

The goal of this work is to reduce the effect of photon noise in dental cone-beam CT reconstruction. We consider an inverse problem formulation and develop a databased prior. To this end, we simulate fan-beam acquisitions and add photon noise to the projection data. The prior is obtained by training a gradient-step denoiser using reconstructed simulated acquisitions. The trained model is integrated into a plug-and-play gradient-step algorithm to reconstruct images from simulated projections. Experiments on synthetic data demonstrate the denoising capabilities of the trained model, while qualitative evaluations on real images showcase the algorithm's performance and generalization ability.

A panoramic X-ray compresses a 3D jaw into a 2D strip; we aim to recover the missing depth cleanly and fast. Existing implicit neural representations render realistic volumes but are slow to train, sensitive to sampling and positional encodings, and costly in practice. Pure CNN baselines are efficient yet struggle with the dental arch's long-range geometry, blur fine enamel-dentin boundaries, and offer little interpretability. We present K-U-KAN, a three-stage pipeline that (i) lifts 2D features into depth-aware observables with Kolmogorov-Arnold Networks, (ii) advances these observables by a stable, phase-aware linear evolution via a Koopman token block, and (iii) places the predicted depth bins onto focal-trough rays before a lightweight 3D attention U-KAN refines the volume. This marriage of physics (Beer-Lambert image formation), geometry (horseshoe focal trough), and learned linear dynamics yields sharp anatomy, fewer artifacts, and robust behavior on native radiographic intensities with batch size one. On held-out data, K-U-KAN matches transformer/implicit baselines on signal and structure metrics, clearly improves perceptual quality, and trains in roughly half the time-making single-view PX $\to$ CBCT reconstruction more practical for clinical pipelines.

This work introduces a continuous soft near-orthogonality score and a resolution-aware saturated coverage objective for projection selection in region-of-interest focused cone-beam CT, grounded in Tuy's completeness theory. Replacing the binary hit-or-miss model of classical Tuy completeness with a graded, differentiable formulation preserves a direct link to achievable feature sizes while enabling both efficient approximate and exact optimisation. We establish that the underlying discrete decision problems are NP-complete via polynomial-time reductions from Set Cover, motivating a submodular greedy algorithm with proven $(1-1/\mathrm{e})$ approximation guarantees and a mixed-integer linear program (MILP) that provides certified optimality bounds. The MILP serves as a quality certificate for the greedy solution rather than a competing optimiser. The primary empirical finding confirms this relationship: across a systematic benchmark spanning six target regions, multiple projection budgets, and four controlled occlusion conditions, the pooled median greedy-to-MILP objective ratio was 0.998, with a substantial fraction of cases certified globally optimal. A binary formulation is included as a diagnostic baseline; it strengthens hard directional completeness but is weaker on the continuous coverage scale. We additionally introduce Effective Spatial Resolution (ESR), a physically interpretable trajectory-level diagnostic that maps directional sampling gaps to achievable feature sizes. ESR correlates reliably with matched reconstruction quality across projection budgets and occlusion levels, providing a practical bridge between the selection stage and the image domain without requiring reconstruction.

Panoramic radiograph (PR) is fundamentally used in routine dental care, but it inherently provides only a two-dimensional (2D) projection of complex three-dimensional (3D) craniofacial anatomy. Most existing learning-based methods attempt to computationally recover this 3D information by directly regressing native cone-beam computed tomography (CBCT) volumes from PR. However, this direct mapping requires the model to simultaneously learn common anatomical structures and patient-specific morphological variations. This entangled formulation makes the ill-posed 2D-to-3D inverse problem highly ambiguous, often producing over-smoothed reconstructions with blurred anatomical boundaries. To address this, we propose HyDAR-Pano3D, a two-stage framework that reformulates PR-to-CBCT reconstruction as a disentangled anatomical recovery problem. In Stage 1, a dual-encoder network integrates radiographic features with SAM-derived semantic priors to reconstruct an arch-normalized canonical volume. In Stage 2, an Anatomical Restoration Network predicts a prior-constrained structured deformation field to map this canonical volume back to the native space, restoring individual morphological variations. Experiments on three large-scale datasets show that HyDAR-Pano3D significantly outperforms baseline methods ($p < 0.05$), achieving a 25.76 dB PSNR, 85.70% SSIM, and an 83.83% overall anatomical Dice score. The synthesized volumes successfully support downstream segmentation of whole teeth (82.4% Dice) and the inferior alveolar canal (72.2% Dice), demonstrating that our disentangled approach preserves clinically relevant structures to enable robust anatomy-aware assessment when CBCT data is unavailable.

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.

Recent advances in generative AI have made synthetic Computed Tomography (CT) images increasingly realistic, enabling promising applications in medical data augmentation while raising serious concerns about clinical safety and data trustworthiness. Detecting AI-generated CT images remains challenging for two key reasons: existing benchmarks cover only limited generation sources, and many detectors are adapted from natural-image forensics without explicitly modeling CT-specific imaging properties. In this paper, we introduce CTForensics, a dataset for detecting AI-generated CT images. CTForensics contains 75,990 2D CT images, including a dedicated test benchmark of 29,990 balanced authentic and generated samples from ten representative CT generative models spanning GAN-based and diffusion-based paradigms. We further propose the Enhanced Spatial-Frequency CT Forgery Detector (ESF-CTFD), a CT-oriented CNN framework built around a Wavelet-Enhanced Central Stem, Multi-Scale Spatial Aggregation, and a Frequency-Aware Prediction Block. The Wavelet-Enhanced Central Stem enhances local intensity correlations and high-frequency residuals, Multi-Scale Spatial Aggregation aligns anatomical features across resolutions with lightweight residual units, and the Frequency-Aware Prediction Block models global spectral artifacts. Extensive experiments on CTForensics show that ESF-CTFD achieves 96.01% mAcc and 99.96% mAP, outperforming existing methods and maintaining strong robustness under realistic perturbations with only a 0.99% average drop. Codes will be available at https://github.com/liyih/CTForensics.

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/.