FSP-Diff: Full-Spectrum Prior-Enhanced DualDomain Latent Diffusion for Ultra-Low-Dose Spectral CT Reconstruction

Spectral computed tomography (CT) with photon-counting detectors holds immense potential for material discrimination and tissue characterization. However, under ultra-low-dose conditions, the sharply degraded signal-to-noise ratio (SNR) in energy-specific projections poses a significant challenge, leading to severe artifacts and loss of structural details in reconstructed images. To address this, we propose FSP-Diff, a full-spectrum prior-enhanced dual-domain latent diffusion framework for ultra-low-dose spectral CT reconstruction. Our framework integrates three core strategies: 1) Complementary Feature Construction: We integrate direct image reconstructions with projection-domain denoised results. While the former preserves latent textural nuances amidst heavy noise, the latter provides a stable structural scaffold to balance detail fidelity and noise suppression. 2) Full-Spectrum Prior Integration: By fusing multi-energy projections into a high-SNR full-spectrum image, we establish a unified structural reference that guides the reconstruction across all energy bins. 3) Efficient Latent Diffusion Synthesis: To alleviate the high computational burden of high-dimensional spectral data, multi-path features are embedded into a compact latent space. This allows the diffusion process to facilitate interactive feature fusion in a lower-dimensional manifold, achieving accelerated reconstruction while maintaining fine-grained detail restoration. Extensive experiments on simulated and real-world datasets demonstrate that FSP-Diff significantly outperforms state-of-the-art methods in both image quality and computational efficiency, underscoring its potential for clinically viable ultra-low-dose spectral CT imaging.

AS-Mamba: Asymmetric Self-Guided Mamba Decoupled Iterative Network for Metal Artifact Reduction

Metal artifact significantly degrades Computed Tomography (CT) image quality, impeding accurate clinical diagnosis. However, existing deep learning approaches, such as CNN and Transformer, often fail to explicitly capture the directional geometric features of artifacts, leading to compromised structural restoration. To address these limitations, we propose the Asymmetric Self-Guided Mamba (AS-Mamba) for metal artifact reduction. Specifically, the linear propagation of metal-induced streak artifacts aligns well with the sequential modeling capability of State Space Models (SSMs). Consequently, the Mamba architecture is leveraged to explicitly capture and suppress these directional artifacts. Simultaneously, a frequency domain correction mechanism is incorporated to rectify the global amplitude spectrum, thereby mitigating intensity inhomogeneity caused by beam hardening. Furthermore, to bridge the distribution gap across diverse clinical scenarios, we introduce a self-guided contrastive regularization strategy. Extensive experiments on public andclinical dental CBCT datasets demonstrate that AS-Mamba achieves superior performance in suppressing directional streaks and preserving structural details, validating the effectiveness of integrating physical geometric priors into deep network design.

Principled Confidence Estimation for Deep Computed Tomography

We present a principled framework for confidence estimation in computed tomography (CT) reconstruction. Based on the sequential likelihood mixing framework (Kirschner et al., 2025), we establish confidence regions with theoretical coverage guarantees for deep-learning-based CT reconstructions. We consider a realistic forward model following the Beer-Lambert law, i.e., a log-linear forward model with Poisson noise, closely reflecting clinical and scientific imaging conditions. The framework is general and applies to both classical algorithms and deep learning reconstruction methods, including U-Nets, U-Net ensembles, and generative Diffusion models. Empirically, we demonstrate that deep reconstruction methods yield substantially tighter confidence regions than classical reconstructions, without sacrificing theoretical coverage guarantees. Our approach allows the detection of hallucinations in reconstructed images and provides interpretable visualizations of confidence regions. This establishes deep models not only as powerful estimators, but also as reliable tools for uncertainty-aware medical imaging.

NAB: Neural Adaptive Binning for Sparse-View CT reconstruction

Computed Tomography (CT) plays a vital role in inspecting the internal structures of industrial objects. Furthermore, achieving high-quality CT reconstruction from sparse views is essential for reducing production costs. While classic implicit neural networks have shown promising results for sparse reconstruction, they are unable to leverage shape priors of objects. Motivated by the observation that numerous industrial objects exhibit rectangular structures, we propose a novel \textbf{N}eural \textbf{A}daptive \textbf{B}inning (\textbf{NAB}) method that effectively integrates rectangular priors into the reconstruction process. Specifically, our approach first maps coordinate space into a binned vector space. This mapping relies on an innovative binning mechanism based on differences between shifted hyperbolic tangent functions, with our extension enabling rotations around the input-plane normal vector. The resulting representations are then processed by a neural network to predict CT attenuation coefficients. This design enables end-to-end optimization of the encoding parameters -- including position, size, steepness, and rotation -- via gradient flow from the projection data, thus enhancing reconstruction accuracy. By adjusting the smoothness of the binning function, NAB can generalize to objects with more complex geometries. This research provides a new perspective on integrating shape priors into neural network-based reconstruction. Extensive experiments demonstrate that NAB achieves superior performance on two industrial datasets. It also maintains robust on medical datasets when the binning function is extended to more general expression. The code will be made available.

Perfusion Imaging and Single Material Reconstruction in Polychromatic Photon Counting CT

Background: Perfusion computed tomography (CT) images the dynamics of a contrast agent through the body over time, and is one of the highest X-ray dose scans in medical imaging. Recently, a theoretically justified reconstruction algorithm based on a monotone variational inequality (VI) was proposed for single material polychromatic photon-counting CT, and showed promising early results at low-dose imaging. Purpose: We adapt this reconstruction algorithm for perfusion CT, to reconstruct the concentration map of the contrast agent while the static background tissue is assumed known; we call our method VI-PRISM (VI-based PeRfusion Imaging and Single Material reconstruction). We evaluate its potential for dose-reduced perfusion CT, using a digital phantom with water and iodine of varying concentration. Methods: Simulated iodine concentrations range from 0.05 to 2.5 mg/ml. The simulated X-ray source emits photons up to 100 keV, with average intensity ranging from $10^5$ down to $10^2$ photons per detector element. The number of tomographic projections was varied from 984 down to 8 to characterize the tradeoff in photon allocation between views and intensity. Results: We compare VI-PRISM against filtered back-projection (FBP), and find that VI-PRISM recovers iodine concentration with error below 0.4 mg/ml at all source intensity levels tested. Even with a dose reduction between 10x and 100x compared to FBP, VI-PRISM exhibits reconstruction quality on par with FBP. Conclusion: Across all photon budgets and angular sampling densities tested, VI-PRISM achieved consistently lower RMSE, reduced noise, and higher SNR compared to filtered back-projection. Even in extremely photon-limited and sparsely sampled regimes, VI-PRISM recovered iodine concentrations with errors below 0.4 mg/ml, showing that VI-PRISM can support accurate and dose-efficient perfusion imaging in photon-counting CT.

Radioactive 3D Gaussian Ray Tracing for Tomographic Reconstruction

3D Gaussian Splatting (3DGS) has recently emerged in computer vision as a promising rendering technique. By adapting the principles of Elliptical Weighted Average (EWA) splatting to a modern differentiable pipeline, 3DGS enables real-time, high-quality novel view synthesis. Building upon this, R2-Gaussian extended the 3DGS paradigm to tomographic reconstruction by rectifying integration bias, achieving state-of-the-art performance in computed tomography (CT). To enable differentiability, R2-Gaussian adopts a local affine approximation: each 3D Gaussian is locally mapped to a 2D Gaussian on the detector and composed via alpha blending to form projections. However, the affine approximation can degrade reconstruction quantitative accuracy and complicate the incorporation of nonlinear geometric corrections. To address these limitations, we propose a tomographic reconstruction framework based on 3D Gaussian ray tracing. Our approach provides two key advantages over splatting-based models: (i) it computes the line integral through 3D Gaussian primitives analytically, avoiding the local affine collapse and thus yielding a more physically consistent forward projection model; and (ii) the ray-tracing formulation gives explicit control over ray origins and directions, which facilitates the precise application of nonlinear geometric corrections, e.g., arc-correction used in positron emission tomography (PET). These properties extend the applicability of Gaussian-based reconstruction to a wider range of realistic tomography systems while improving projection accuracy.

Auditing Sybil: Explaining Deep Lung Cancer Risk Prediction Through Generative Interventional Attributions

Lung cancer remains the leading cause of cancer mortality, driving the development of automated screening tools to alleviate radiologist workload. Standing at the frontier of this effort is Sybil, a deep learning model capable of predicting future risk solely from computed tomography (CT) with high precision. However, despite extensive clinical validation, current assessments rely purely on observational metrics. This correlation-based approach overlooks the model's actual reasoning mechanism, necessitating a shift to causal verification to ensure robust decision-making before clinical deployment. We propose S(H)NAP, a model-agnostic auditing framework that constructs generative interventional attributions validated by expert radiologists. By leveraging realistic 3D diffusion bridge modeling to systematically modify anatomical features, our approach isolates object-specific causal contributions to the risk score. Providing the first interventional audit of Sybil, we demonstrate that while the model often exhibits behavior akin to an expert radiologist, differentiating malignant pulmonary nodules from benign ones, it suffers from critical failure modes, including dangerous sensitivity to clinically unjustified artifacts and a distinct radial bias.

Hypernetwork-Based Adaptive Aggregation for Multimodal Multiple-Instance Learning in Predicting Coronary Calcium Debulking

In this paper, we present the first attempt to estimate the necessity of debulking coronary artery calcifications from computed tomography (CT) images. We formulate this task as a Multiple-instance Learning (MIL) problem. The difficulty of this task lies in that physicians adjust their focus and decision criteria for device usage according to tabular data representing each patient's condition. To address this issue, we propose a hypernetwork-based adaptive aggregation transformer (HyperAdAgFormer), which adaptively modifies the feature aggregation strategy for each patient based on tabular data through a hypernetwork. The experiments using the clinical dataset demonstrated the effectiveness of HyperAdAgFormer. The code is publicly available at https://github.com/Shiku-Kaito/HyperAdAgFormer.

Visible Singularities Guided Correlation Network for Limited-Angle CT Reconstruction

Limited-angle computed tomography (LACT) offers the advantages of reduced radiation dose and shortened scanning time. Traditional reconstruction algorithms exhibit various inherent limitations in LACT. Currently, most deep learning-based LACT reconstruction methods focus on multi-domain fusion or the introduction of generic priors, failing to fully align with the core imaging characteristics of LACT-such as the directionality of artifacts and directional loss of structural information, which are caused by the absence of projection angles in certain directions. Inspired by the theory of visible and invisible singularities, taking into account the aforementioned core imaging characteristics of LACT, we propose a Visible Singularities Guided Correlation network for LACT reconstruction (VSGC). The design philosophy of VSGC consists of two core steps: First, extract VS edge features from LACT images and focus the model's attention on these VS. Second, establish correlations between the VS edge features and other regions of the image. Additionally, a multi-scale loss function with anisotropic constraint is employed to constrain the model to converge in multiple aspects. Finally, qualitative and quantitative validations are conducted on both simulated and real datasets to verify the effectiveness and feasibility of the proposed design. Particularly, in comparison with alternative methods, VSGC delivers more prominent performance in small angular ranges, with the PSNR improvement of 2.45 dB and the SSIM enhancement of 1.5\%. The code is publicly available at https://github.com/yqx7150/VSGC.

Low performing pixel correction in computed tomography with unrolled network and synthetic data training

Low performance pixels (LPP) in Computed Tomography (CT) detectors would lead to ring and streak artifacts in the reconstructed images, making them clinically unusable. In recent years, several solutions have been proposed to correct LPP artifacts, either in the image domain or in the sinogram domain using supervised deep learning methods. However, these methods require dedicated datasets for training, which are expensive to collect. Moreover, existing approaches focus solely either on image-space or sinogram-space correction, ignoring the intrinsic correlations from the forward operation of the CT geometry. In this work, we propose an unrolled dual-domain method based on synthetic data to correct LPP artifacts. Specifically, the intrinsic correlations of LPP between the sinogram and image domains are leveraged through synthetic data generated from natural images, enabling the trained model to correct artifacts without requiring any real-world clinical data. In experiments simulating 1-2% detectors defect near the isocenter, the proposed method outperformed the state-of-the-art approaches by a large margin. The results indicate that our solution can correct LPP artifacts without the cost of data collection for model training, and it is adaptable to different scanner settings for software-based applications.