Detail Consistent Stage-Wise Distillation for Efficient 3D MRI Segmentation

Deploying high-performing 3D medical image segmenters (e.g., nnU-Net) is often limited by memory footprint and inference latency. Compression is therefore necessary, but compact 3D encoders tend to lose fine structural cues (small lesions and sharp boundaries) as downsampling repeats across multi-resolution stages. We propose Detail Consistent Distillation (DCD), a stage-wise distillation framework that preserves structural detail across scales by aligning teacher-student features in a wavelet-decomposed representation. At each encoder stage, DCD distills directional detail components in the wavelet domain while leaving the coarse approximation comparatively unconstrained, avoiding over-regularization of global semantics. DCD is used only during training and introduces no inference-time overhead. Experiments on the BraTS 2024 and ISLES 2022 benchmarks demonstrate that our approach achieves superior performance in MRI segmentation using 3D multi-modal data. Code and implementation details for DCD are publicly available at https://github.com/ClinicaAlpha/DCD-3D-MedSeg.

Speech-Guided Multimodal Learning for Vocal Tract Segmentation in Real-Time MRI

Segmenting vocal tract articulators in real-time MRI (rtMRI) is a challenging dynamic image segmentation problem characterized by low contrast, rapid motion, and limited spatial resolution. However, while rtMRI acquisitions may provide synchronized acoustic signals, existing methods discard this information, and the few multimodal approaches that incorporate audio cannot be deployed when audio is unavailable. We propose a three-stage framework that leverages acoustic and phonological supervision during training while requiring only the rtMRI image at inference: phonological representations are converted into spatial bounding-box priors for articulator localization, visual and acoustic encoders are aligned via dual-level cross-modal contrastive pretraining, and the learned representations are fused through a cross-attention decoder, effectively transferring multimodal knowledge into a single-modality inference pipeline. Evaluated on 75-Speaker~Annot-16 and USC-TIMIT datasets, our method outperforms existing unimodal and multimodal methods, demonstrating that multimodal supervision provides transferable benefits for precise and clinically deployable vocal tract segmentation.

Generating synthetic computed tomography for radiotherapy: SynthRAD2025 challenge report

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.

Generative Drifting for Conditional Medical Image Generation

Conditional medical image generation plays an important role in many clinically relevant imaging tasks. However, existing methods still face a fundamental challenge in balancing inference efficiency, patient-specific fidelity, and distribution-level plausibility, particularly in high-dimensional 3D medical imaging. In this work, we propose GDM, a generative drifting framework that reformulates deterministic medical image prediction as a multi-objective learning problem to jointly promote distribution-level plausibility and patient-specific fidelity while retaining one-step inference. GDM extends drifting to 3D medical imaging through an attractive-repulsive drift that minimizes the discrepancy between the generator pushforward and the target distribution. To enable stable drifting-based learning in 3D volumetric data, GDM constructs a multi-level feature bank from a medical foundation encoder to support reliable affinity estimation and drifting field computation across complementary global, local, and spatial representations. In addition, a gradient coordination strategy in the shared output space improves optimization balance under competing distribution-level and fidelity-oriented objectives. We evaluate the proposed framework on two representative tasks, MRI-to-CT synthesis and sparse-view CT reconstruction. Experimental results show that GDM consistently outperforms a wide range of baselines, including GAN-based, flow-matching-based, and SDE-based generative models, as well as supervised regression methods, while improving the balance among anatomical fidelity, quantitative reliability, perceptual realism, and inference efficiency. These findings suggest that GDM provides a practical and effective framework for conditional 3D medical image generation.

GANeXt: A Fully ConvNeXt-Enhanced Generative Adversarial Network for MRI- and CBCT-to-CT Synthesis

The synthesis of computed tomography (CT) from magnetic resonance imaging (MRI) and cone-beam CT (CBCT) plays a critical role in clinical treatment planning by enabling accurate anatomical representation in adaptive radiotherapy. In this work, we propose GANeXt, a 3D patch-based, fully ConvNeXt-powered generative adversarial network for unified CT synthesis across different modalities and anatomical regions. Specifically, GANeXt employs an efficient U-shaped generator constructed from stacked 3D ConvNeXt blocks with compact convolution kernels, while the discriminator adopts a conditional PatchGAN. To improve synthesis quality, we incorporate a combination of loss functions, including mean absolute error (MAE), perceptual loss, segmentation-based masked MAE, and adversarial loss and a combination of Dice loss and cross-entropy for multi-head segmentation discriminator. For both tasks, training is performed with a batch size of 8 using two separate AdamW optimizers for the generator and discriminator, each equipped with a warmup and cosine decay scheduler, with learning rates of $5\times10^{-4}$ and $1\times10^{-3}$, respectively. Data preprocessing includes deformable registration, foreground cropping, percentile normalization for the input modality, and linear normalization of the CT to the range $[-1024, 1000]$. Data augmentation involves random zooming within $(0.8, 1.3)$ (for MRI-to-CT only), fixed-size cropping to $32\times160\times192$ for MRI-to-CT and $32\times128\times128$ for CBCT-to-CT, and random flipping. During inference, we apply a sliding-window approach with $0.8$ overlap and average folding to reconstruct the full-size sCT, followed by inversion of the CT normalization. After joint training on all regions without any fine-tuning, the final models are selected at the end of 3000 epochs for MRI-to-CT and 1000 epochs for CBCT-to-CT using the full training dataset.

Learning Wavelet-Sparse FDK for 3D Cone-Beam CT Reconstruction

Cone-Beam Computed Tomography (CBCT) is essential in medical imaging, and the Feldkamp-Davis-Kress (FDK) algorithm is a popular choice for reconstruction due to its efficiency. However, FDK is susceptible to noise and artifacts. While recent deep learning methods offer improved image quality, they often increase computational complexity and lack the interpretability of traditional methods. In this paper, we introduce an enhanced FDK-based neural network that maintains the classical algorithm's interpretability by selectively integrating trainable elements into the cosine weighting and filtering stages. Recognizing the challenge of a large parameter space inherent in 3D CBCT data, we leverage wavelet transformations to create sparse representations of the cosine weights and filters. This strategic sparsification reduces the parameter count by $93.75\%$ without compromising performance, accelerates convergence, and importantly, maintains the inference computational cost equivalent to the classical FDK algorithm. Our method not only ensures volumetric consistency and boosts robustness to noise, but is also designed for straightforward integration into existing CT reconstruction pipelines. This presents a pragmatic enhancement that can benefit clinical applications, particularly in environments with computational limitations.

Filter2Noise: Interpretable Self-Supervised Single-Image Denoising for Low-Dose CT with Attention-Guided Bilateral Filtering

Effective denoising is crucial in low-dose CT to enhance subtle structures and low-contrast lesions while preventing diagnostic errors. Supervised methods struggle with limited paired datasets, and self-supervised approaches often require multiple noisy images and rely on deep networks like U-Net, offering little insight into the denoising mechanism. To address these challenges, we propose an interpretable self-supervised single-image denoising framework -- Filter2Noise (F2N). Our approach introduces an Attention-Guided Bilateral Filter that adapted to each noisy input through a lightweight module that predicts spatially varying filter parameters, which can be visualized and adjusted post-training for user-controlled denoising in specific regions of interest. To enable single-image training, we introduce a novel downsampling shuffle strategy with a new self-supervised loss function that extends the concept of Noise2Noise to a single image and addresses spatially correlated noise. On the Mayo Clinic 2016 low-dose CT dataset, F2N outperforms the leading self-supervised single-image method (ZS-N2N) by 4.59 dB PSNR while improving transparency, user control, and parametric efficiency. These features provide key advantages for medical applications that require precise and interpretable noise reduction. Our code is demonstrated at https://github.com/sypsyp97/Filter2Noise.git .

DRACO: Differentiable Reconstruction for Arbitrary CBCT Orbits

This paper introduces a novel method for reconstructing cone beam computed tomography (CBCT) images for arbitrary orbits using a differentiable shift-variant filtered backprojection (FBP) neural network. Traditional CBCT reconstruction methods for arbitrary orbits, like iterative reconstruction algorithms, are computationally expensive and memory-intensive. The proposed method addresses these challenges by employing a shift-variant FBP algorithm optimized for arbitrary trajectories through a deep learning approach that adapts to a specific orbit geometry. This approach overcomes the limitations of existing techniques by integrating known operators into the learning model, minimizing the number of parameters, and improving the interpretability of the model. The proposed method is a significant advancement in interventional medical imaging, particularly for robotic C-arm CT systems, enabling faster and more accurate CBCT reconstructions with customized orbits. Especially this method can also be used for the analytical reconstruction of non-continuous orbits like circular plus arc. The experimental results demonstrate that the proposed method significantly accelerates the reconstruction process compared to conventional iterative algorithms. It achieves comparable or superior image quality, as evidenced by metrics such as the mean squared error (MSE), the peak signal-to-noise ratio (PSNR), and the structural similarity index measure (SSIM). The validation experiments show that the method can handle data from different trajectories, demonstrating its flexibility and robustness across different scan geometries. Our method demonstrates a significant improvement, particularly for the sinusoidal trajectory, achieving a 38.6% reduction in MSE, a 7.7% increase in PSNR, and a 5.0% improvement in SSIM. Furthermore, the computation time for reconstruction was reduced by more than 97%.

On the Influence of Smoothness Constraints in Computed Tomography Motion Compensation

Computed tomography (CT) relies on precise patient immobilization during image acquisition. Nevertheless, motion artifacts in the reconstructed images can persist. Motion compensation methods aim to correct such artifacts post-acquisition, often incorporating temporal smoothness constraints on the estimated motion patterns. This study analyzes the influence of a spline-based motion model within an existing rigid motion compensation algorithm for cone-beam CT on the recoverable motion frequencies. Results demonstrate that the choice of motion model crucially influences recoverable frequencies. The optimization-based motion compensation algorithm is able to accurately fit the spline nodes for frequencies almost up to the node-dependent theoretical limit according to the Nyquist-Shannon theorem. Notably, a higher node count does not compromise reconstruction performance for slow motion patterns, but can extend the range of recoverable high frequencies for the investigated algorithm. Eventually, the optimal motion model is dependent on the imaged anatomy, clinical use case, and scanning protocol and should be tailored carefully to the expected motion frequency spectrum to ensure accurate motion compensation.

Differentiable Score-Based Likelihoods: Learning CT Motion Compensation From Clean Images

Motion artifacts can compromise the diagnostic value of computed tomography (CT) images. Motion correction approaches require a per-scan estimation of patient-specific motion patterns. In this work, we train a score-based model to act as a probability density estimator for clean head CT images. Given the trained model, we quantify the deviation of a given motion-affected CT image from the ideal distribution through likelihood computation. We demonstrate that the likelihood can be utilized as a surrogate metric for motion artifact severity in the CT image facilitating the application of an iterative, gradient-based motion compensation algorithm. By optimizing the underlying motion parameters to maximize likelihood, our method effectively reduces motion artifacts, bringing the image closer to the distribution of motion-free scans. Our approach achieves comparable performance to state-of-the-art methods while eliminating the need for a representative data set of motion-affected samples. This is particularly advantageous in real-world applications, where patient motion patterns may exhibit unforeseen variability, ensuring robustness without implicit assumptions about recoverable motion types.