Low-dose CT via convolutional neural network

BreathVisionNet: A pulmonary-function-guided CNN-transformer hybrid model for expiratory CT image synthesis

BACKGROUND AND OBJECTIVE

Chronic obstructive pulmonary disease (COPD) has high heterogeneity in etiologies and clinical manifestations. Expiratory Computed tomography (CT) can effectively assess air trapping, aiding in disease diagnosis. However, due to concerns about radiation exposure and cost, expiratory CT is not routinely performed. Recent work on synthesizing expiratory CT has primarily focused on imaging features while neglecting patient-specific pulmonary function.

METHODS

To address these issues, we developed a novel model named BreathVisionNet that incorporates pulmonary function data to guide the synthesis of expiratory CT from inspiratory CT. An architecture combining a convolutional neural network and transformer is introduced to leverage the irregular phenotypic distribution in COPD patients. The model can better understand the long-range and global contexts by incorporating global information into the encoder. The utilization of edge information and multi-view data further enhances the quality of the synthesized CT. Parametric response mapping (PRM) can be estimated by using synthesized expiratory CT and inspiratory CT to quantify COPD phenotypes of the normal, emphysema, and functional small airway disease (fSAD), including their percentages, spatial distributions, and voxel distribution maps.

RESULTS

BreathVisionNet outperforms other generative models in terms of synthesized image quality. It achieves a mean absolute error, normalized mean square error, structural similarity index and peak signal-to-noise ratio of 78.207 HU, 0.643, 0.847 and 25.828 dB, respectively. Comparing the predicted and real PRM, the Dice coefficient can reach 0.732 (emphysema) and 0.560 (fSAD). The mean of differences between true and predicted fSAD percentage is 4.42 for the development dataset (low radiation dose CT scans), and 9.05 for an independent external validation dataset (routine dose), indicating that model has great generalizability. A classifier trained on voxel distribution maps can achieve an accuracy of 0.891 in predicting the presence of COPD.

CONCLUSIONS

BreathVisionNet can accurately synthesize expiratory CT images from inspiratory CT and predict their voxel distribution. The estimated PRM can help to quantify COPD phenotypes of the normal, emphysema, and fSAD. This capability provides additional insights into COPD diversity while only inspiratory CT images are available.

Implicit neural representation-based method for metal-induced beam hardening artifact reduction in X-ray CT imaging

BACKGROUND

In X-ray computed tomography (CT), metal-induced beam hardening artifacts arise from the complex interactions between polychromatic X-ray beams and metallic objects, leading to degraded image quality and impeding accurate diagnosis. A previously proposed metal-induced beam hardening correction (MBHC) method provides a theoretical framework for addressing nonlinear artifacts through mathematical analysis, with its effectiveness demonstrated by numerical simulations and phantom experiments. However, in practical applications, this method relies on precise segmentation of highly attenuating materials and parameter estimations, which limit its ability to fully correct artifacts caused by the intricate interactions between metals and other dense materials, such as bone or teeth.

PURPOSE

This study aims to develop a parameter-free MBHC method that eliminates the need for accurate segmentation and parameter estimations, thereby addressing the limitations of the original MBHC approach.

METHODS

The proposed method employs implicit neural representations (INR) to generate two tomographic images: one representing the monochromatic attenuation distribution at a specific energy level, and another capturing the nonlinear beam hardening effects caused by the polychromatic nature of X-ray beams. A loss function drives the generation of these images, where the predicted projection data is nonlinearly modeled by the combination of the two images. This approach eliminates the need for geometric and parameter estimation of metals, providing a more generalized solution.

RESULTS

Numerical and phantom experiments demonstrates that the proposed method effectively reduces beam hardening artifacts caused by interactions between highly attenuating materials such as metals, bone, and teeth. Additionally, the proposed INR-based method demonstrates potential in addressing challenges related to data insufficiencies, such as photon starvation and truncated fields of view in CT imaging.

CONCLUSIONS

The proposed generalized MBHC method provides high-quality image reconstructions without requiring parameter estimations and segmentations, offering a robust solution for reducing metal-induced beam hardening artifacts in CT imaging.

Deep learning-based image domain reconstruction enhances image quality and pulmonary nodule detection in ultralow-dose CT with adaptive statistical iterative reconstruction-V

OBJECTIVES

To evaluate the image quality and lung nodule detectability of ultralow-dose CT (ULDCT) with adaptive statistical iterative reconstruction-V (ASiR-V) post-processed using a deep learning image reconstruction (DLIR)-based image domain compared to low-dose CT (LDCT) and ULDCT without DLIR.

MATERIALS AND METHODS

A total of 210 patients undergoing lung cancer screening underwent LDCT (mean ± SD, 0.81 ± 0.28 mSv) and ULDCT (0.17 ± 0.03 mSv) scans. ULDCT images were reconstructed with ASiR-V (ULDCT-ASiR-V) and post-processed using DLIR (ULDCT-DLIR). The quality of the three CT images was analyzed. Three radiologists detected and measured pulmonary nodules on all CT images, with LDCT results serving as references. Nodule conspicuity was assessed using a five-point Likert scale, followed by further statistical analyses.

RESULTS

A total of 463 nodules were detected using LDCT. The image noise of ULDCT-DLIR decreased by 60% compared to that of ULDCT-ASiR-V and was lower than that of LDCT (p < 0.001). The subjective image quality scores for ULDCT-DLIR (4.4 [4.1, 4.6]) were also higher than those for ULDCT-ASiR-V (3.6 [3.1, 3.9]) (p < 0.001). The overall nodule detection rates for ULDCT-ASiR-V and ULDCT-DLIR were 82.1% (380/463) and 87.0% (403/463), respectively (p < 0.001). The percentage difference between diameters > 1 mm was 2.9% (ULDCT-ASiR-V vs. LDCT) and 0.5% (ULDCT-DLIR vs. LDCT) (p = 0.009). Scores of nodule imaging sharpness on ULDCT-DLIR (4.0 ± 0.68) were significantly higher than those on ULDCT-ASiR-V (3.2 ± 0.50) (p < 0.001).

CONCLUSION

DLIR-based image domain improves image quality, nodule detection rate, nodule imaging sharpness, and nodule measurement accuracy of ASiR-V on ULDCT.

KEY POINTS

Question Deep learning post-processing is simple and cheap compared with raw data processing, but its performance is not clear on ultralow-dose CT. Findings Deep learning post-processing enhanced image quality and improved the nodule detection rate and accuracy of nodule measurement of ultralow-dose CT. Clinical relevance Deep learning post-processing improves the practicability of ultralow-dose CT and makes it possible for patients with less radiation exposure during lung cancer screening.

Reconstructing and analyzing the invariances of low-dose CT image denoising networks

BACKGROUND

Deep learning-based methods led to significant advancements in many areas of medical imaging, most of which are concerned with the reduction of artifacts caused by motion, scatter, or noise. However, with most neural networks being black boxes, they remain notoriously difficult to interpret, hindering their clinical implementation. In particular, it has been shown that networks exhibit invariances w.r.t. input features, that is, they learn to ignore certain information in the input data.

PURPOSE

To improve the interpretability of deep learning-based low-dose CT image denoising networks.

METHODS

We learn a complete data representation of low-dose input images using a conditional variational autoencoder (cVAE). In this representation, invariances of any given denoising network are then disentangled from the information it is not invariant to using a conditional invertible neural network (cINN). At test time, image-space invariances are generated by applying the inverse of the cINN and subsequent decoding using the cVAE. We propose two methods to analyze sampled invariances and to find those that correspond to alterations of anatomical structures.

RESULTS

The proposed method is applied to four popular deep learning-based low-dose CT image denoising networks. We find that the networks are not only invariant to noise amplitude and realizations, but also to anatomical structures.

CONCLUSIONS

The proposed method is capable of reconstructing and analyzing invariances of deep learning-based low-dose CT image denoising networks. This is an important step toward interpreting deep learning-based methods for medical imaging, which is essential for their clinical implementation.

Enhancing Ultrasound Image Quality Across Disease Domains: Application of Cycle-Consistent Generative Adversarial Network and Perceptual Loss

BACKGROUND

Numerous studies have explored image processing techniques aimed at enhancing ultrasound images to narrow the performance gap between low-quality portable devices and high-end ultrasound equipment. These investigations often use registered image pairs created by modifying the same image through methods like down sampling or adding noise, rather than using separate images from different machines. Additionally, they rely on organ-specific features, limiting the models' generalizability across various imaging conditions and devices. The challenge remains to develop a universal framework capable of improving image quality across different devices and conditions, independent of registration or specific organ characteristics.

OBJECTIVE

This study aims to develop a robust framework that enhances the quality of ultrasound images, particularly those captured with compact, portable devices, which are often constrained by low quality due to hardware limitations. The framework is designed to effectively process nonregistered ultrasound image pairs, a common challenge in medical imaging, across various clinical settings and device types. By addressing these challenges, the research seeks to provide a more generalized and adaptable solution that can be widely applied across diverse medical scenarios, improving the accessibility and quality of diagnostic imaging.

METHODS

A retrospective analysis was conducted by using a cycle-consistent generative adversarial network (CycleGAN) framework enhanced with perceptual loss to improve the quality of ultrasound images, focusing on nonregistered image pairs from various organ systems. The perceptual loss was integrated to preserve anatomical integrity by comparing deep features extracted from pretrained neural networks. The model's performance was evaluated against corresponding high-resolution images, ensuring that the enhanced outputs closely mimic those from high-end ultrasound devices. The model was trained and validated using a publicly available, diverse dataset to ensure robustness and generalizability across different imaging scenarios.

RESULTS

The advanced CycleGAN framework, enhanced with perceptual loss, significantly outperformed the previous state-of-the-art, stable CycleGAN, in multiple evaluation metrics. Specifically, our method achieved a structural similarity index of 0.2889 versus 0.2502 (P<.001), a peak signal-to-noise ratio of 15.8935 versus 14.9430 (P<.001), and a learned perceptual image patch similarity score of 0.4490 versus 0.5005 (P<.001). These results demonstrate the model's superior ability to enhance image quality while preserving critical anatomical details, thereby improving diagnostic usefulness.

CONCLUSIONS

This study presents a significant advancement in ultrasound imaging by leveraging a CycleGAN model enhanced with perceptual loss to bridge the quality gap between images from different devices. By processing nonregistered image pairs, the model not only enhances visual quality but also ensures the preservation of essential anatomical structures, crucial for accurate diagnosis. This approach holds the potential to democratize high-quality ultrasound imaging, making it accessible through low-cost portable devices, thereby improving health care outcomes, particularly in resource-limited settings. Future research will focus on further validation and optimization for clinical use.

DDoCT: Morphology preserved dual-domain joint optimization for fast sparse-view low-dose CT imaging

Computed tomography (CT) is continuously becoming a valuable diagnostic technique in clinical practice. However, the radiation dose exposure in the CT scanning process is a public health concern. Within medical diagnoses, mitigating the radiation risk to patients can be achieved by reducing the radiation dose through adjustments in tube current and/or the number of projections. Nevertheless, dose reduction introduces additional noise and artifacts, which have extremely detrimental effects on clinical diagnosis and subsequent analysis. In recent years, the feasibility of applying deep learning methods to low-dose CT (LDCT) imaging has been demonstrated, leading to significant achievements. This article proposes a dual-domain joint optimization LDCT imaging framework (termed DDoCT) which uses noisy sparse-view projection to reconstruct high-performance CT images with joint optimization in projection and image domains. The proposed method not only addresses the noise introduced by reducing tube current, but also pays special attention to issues such as streak artifacts caused by a reduction in the number of projections, enhancing the applicability of DDoCT in practical fast LDCT imaging environments. Experimental results have demonstrated that DDoCT has made significant progress in reducing noise and streak artifacts and enhancing the contrast and clarity of the images.

Benchmarking deep learning-based low-dose CT image denoising algorithms

BACKGROUND

Long-lasting efforts have been made to reduce radiation dose and thus the potential radiation risk to the patient for computed tomography (CT) acquisitions without severe deterioration of image quality. To this end, various techniques have been employed over the years including iterative reconstruction methods and noise reduction algorithms.

PURPOSE

Recently, deep learning-based methods for noise reduction became increasingly popular and a multitude of papers claim ever improving performance both quantitatively and qualitatively. However, the lack of a standardized benchmark setup and inconsistencies in experimental design across studies hinder the verifiability and reproducibility of reported results.

METHODS

In this study, we propose a benchmark setup to overcome those flaws and improve reproducibility and verifiability of experimental results in the field. We perform a comprehensive and fair evaluation of several state-of-the-art methods using this standardized setup.

RESULTS

Our evaluation reveals that most deep learning-based methods show statistically similar performance, and improvements over the past years have been marginal at best.

CONCLUSIONS

This study highlights the need for a more rigorous and fair evaluation of novel deep learning-based methods for low-dose CT image denoising. Our benchmark setup is a first and important step towards this direction and can be used by future researchers to evaluate their algorithms.

AI-based 3D analysis of retinal vasculature associated with retinal diseases using OCT angiography

Retinal vasculature is the only vascular system in the human body that can be observed in a non-invasive manner, with a phenotype associated with a wide range of ocular, cerebral, and cardiovascular diseases. OCT and OCT angiography (OCTA) provide powerful imaging methods to visualize the three-dimensional morphological and functional information of the retina. In this study, based on OCT and OCTA multimodal inputs, a multitask convolutional neural network model was built to realize 3D segmentation of retinal blood vessels and disease classification for different retinal diseases, overcoming the limitations of existing methods that can only perform 2D analysis of OCTA. Two hundred thirty sets of OCT and OCTA data from 109 patients, including 138,000 cross-sectional images in normal and diseased eyes (age-related macular degeneration, retinal vein occlusion, and central serous chorioretinopathy), were collected from four commercial OCT systems for model training, validation, and testing. Experimental results verified that the proposed method was able to achieve a DICE coefficient of 0.956 for 3D segmentation of blood vessels and an accuracy of 91.49% for disease classification, and further enabled us to evaluate the 3D reconstruction of retinal vessels, explore the interlayer connections of superficial and deep vasculatures, and reveal the 3D quantitative vessel characteristics in different retinal diseases.

Self-supervised learning for CT image denoising and reconstruction: a review

This article reviews the self-supervised learning methods for CT image denoising and reconstruction. Currently, deep learning has become a dominant tool in medical imaging as well as computer vision. In particular, self-supervised learning approaches have attracted great attention as a technique for learning CT images without clean/noisy references. After briefly reviewing the fundamentals of CT image denoising and reconstruction, we examine the progress of deep learning in CT image denoising and reconstruction. Finally, we focus on the theoretical and methodological evolution of self-supervised learning for image denoising and reconstruction.

An efficient dual-domain deep learning network for sparse-view CT reconstruction

BACKGROUND AND OBJECTIVE

We develop an efficient deep-learning based dual-domain reconstruction method for sparse-view CT reconstruction with small training parameters and comparable running time. We aim to investigate the model's capability and its clinical value by performing objective and subjective quality assessments using clinical CT projection data acquired on commercial scanners.

METHODS

We designed two lightweight networks, namely Sino-Net and Img-Net, to restore the projection and image signal from the DD-Net reconstructed images in the projection and image domains, respectively. The proposed network has small training parameters and comparable running time among dual-domain based reconstruction networks and is easy to train (end-to-end). We prospectively collected clinical thoraco-abdominal CT projection data acquired on a Siemens Biograph 128 Edge CT scanner to train and validate the proposed network. Further, we quantitatively evaluated the CT Hounsfield unit (HU) values on 21 organs and anatomic structures, such as the liver, aorta, and ribcage. We also analyzed the noise properties and compared the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) of the reconstructed images. Besides, two radiologists conducted the subjective qualitative evaluation including the confidence and conspicuity of anatomic structures, and the overall image quality using a 1-5 likert scoring system.

RESULTS

Objective and subjective evaluation showed that the proposed algorithm achieves competitive results in eliminating noise and artifacts, restoring fine structure details, and recovering edges and contours of anatomic structures using 384 views (1/6 sparse rate). The proposed method exhibited good computational cost performance on clinical projection data.

CONCLUSION

This work presents an efficient dual-domain learning network for sparse-view CT reconstruction on raw projection data from a commercial scanner. The study also provides insights for designing an organ-based image quality assessment pipeline for sparse-view reconstruction tasks, potentially benefiting organ-specific dose reduction by sparse-view imaging.

A Review of Factors Affecting Radiation Dose and Image Quality in Coronary CTA Performed with Wide-Detector CT

Compared with traditional invasive coronary angiography (ICA), coronary CT angiography (CCTA) has the advantages of being rapid, economical, and minimally invasive. The wide-detector CT, with its superior temporal resolution and robust three-dimensional reconstruction technology, thus enables CCTA in patients with high heart rates and arrhythmias, leading to a high potential for clinical application. This paper systematically summarizes wide-detector CT hardware configurations of various vendors routinely used for CCTA examinations and reviews the effects of patient heart rate and heart rate variability, scanning modality, reconstruction algorithms, tube voltage, and scanning field of view on image quality and radiation dose. In addition, novel technologies in the field of CT applied to CCTA examinations are also presented. Since this examination has a diagnostic accuracy that is highly consistent with ICA, it can be further used as a routine examination tool for coronary artery disease in clinical practice.

PET image reconstruction using weighted nuclear norm maximization and deep learning prior

The ill-posed Positron emission tomography (PET) reconstruction problem usually results in limited resolution and significant noise. Recently, deep neural networks have been incorporated into PET iterative reconstruction framework to improve the image quality. In this paper, we propose a new neural network-based iterative reconstruction method by using weighted nuclear norm (WNN) maximization, which aims to recover the image details in the reconstruction process. The novelty of our method is the application of WNN maximization rather than WNN minimization in PET image reconstruction. Meanwhile, a neural network is used to control the noise originated from WNN maximization. Our method is evaluated on simulated and clinical datasets. The simulation results show that the proposed approach outperforms state-of-the-art neural network-based iterative methods by achieving the best contrast/noise tradeoff with a remarkable contrast improvement on the lesion contrast recovery. The study on clinical datasets also demonstrates that our method can recover lesions of different sizes while suppressing noise in various low-dose PET image reconstruction tasks. Our code is available athttps://github.com/Kuangxd/PETReconstruction.

Deep learning-based reconstruction improves the image quality of low-dose CT enterography in patients with inflammatory bowel disease

PURPOSE

Lifelong re-examination of CT enterography (CTE) in patients with inflammatory bowel disease (IBD) may be necessary, and reducing radiation exposure during CT examinations is crucial. We investigated the potential application of deep learning reconstruction (DLR) in CTE to reduce radiation dose and improve image quality in IBD.

METHODS

Thirty-six patients with known or suspected IBD were prospectively recruited to the low-dose CTE (LDCTE) group, while forty patients were retrospectively selected from previous clinical standard-dose CTE (STDCTE) scans as controls. STDCTE images were reconstructed with hybrid-IR (adaptive iterative dose reduction 3-dimensional [AIDR3D], standard setting); LDCTE images were reconstructed with AIDR3D and DLR (Advanced Intelligence ClearIQ Engine [AiCE], Body mild/standard/strong, Sharp Body mild/standard/strong setting). The effective radiation dose (ED), image noise, signal-to-noise ratio (SNR), overall image quality, subjective image noise, and diagnostic effectiveness were compared between the LDCTE and STDCTE groups.

RESULTS

Compared with STDCTE, the ED of LDCTE was lower by 54.1% (p<0.001). Compared with STDCTE-AIDR3D, LDCTE-AIDR3D reconstruction objective image noise and SNR were greater (p<0.05), the subjective overall image quality was lower (p<0.05), and the diagnostic efficiency was lower (AUC=0.52, p<0.05). The SNRs of reconstructedimages of LDCTE-AiCE Body Strong and LDCTE-AiCE Body Sharp standard/strong groups were greater than that of STDCTE-AIDR3D group (all p<0.05), and the diagnostic performance was better than or comparable to that of STDCTE; the AUCs were 0.83, 0.76 and 0.76, respectively CONCLUSION: Compared with STDCTE with AIDR3D, LDCTE with DLR effectively reduced the radiation dose and improve image quality in IBD patients.

Skeletal Muscle Segmentation at the Level of the Third Lumbar Vertebra (L3) in Low-Dose Computed Tomography: A Lightweight Algorithm

BACKGROUND

The cross-sectional area of skeletal muscles at the level of the third lumbar vertebra (L3) measured from computed tomography (CT) images is an established imaging biomarker used to assess patients' nutritional status. With the increasing prevalence of low-dose CT scans in clinical practice, accurate and automated skeletal muscle segmentation at the L3 level in low-dose CT images has become an issue to address. This study proposed a lightweight algorithm for automated segmentation of skeletal muscles at the L3 level in low-dose CT images.

METHODS

This study included 57 patients with rectal cancer, with both low-dose plain and contrast-enhanced pelvic CT image series acquired using a radiotherapy CT scanner. A training set of 30 randomly selected patients was used to develop a lightweight segmentation algorithm, and the other 27 patients were used as the test set. A radiologist selected the most representative axial CT image at the L3 level for both the image series for all the patients, and three groups of observers manually annotated the skeletal muscles in the 54 CT images of the test set as the gold standard. The performance of the proposed algorithm was evaluated in terms of the Dice similarity coefficient (DSC), precision, recall, 95th percentile of the Hausdorff distance (HD95), and average surface distance (ASD). The running time of the proposed algorithm was recorded. An open source deep learning-based AutoMATICA algorithm was compared with the proposed algorithm. The inter-observer variations were also used as the reference.

RESULTS

The DSC, precision, recall, HD95, ASD, and running time were 93.2 ± 1.9% (mean ± standard deviation), 96.7 ± 2.9%, 90.0 ± 2.9%, 4.8 ± 1.3 mm, 0.8 ± 0.2 mm, and 303 ± 43 ms (on CPU) for the proposed algorithm, and 94.1 ± 4.1%, 92.7 ± 5.5%, 95.7 ± 4.0%, 7.4 ± 5.7 mm, 0.9 ± 0.6 mm, and 448 ± 40 ms (on GPU) for AutoMATICA, respectively. The differences between the proposed algorithm and the inter-observer reference were 4.7%, 1.2%, 7.9%, 3.2 mm, and 0.6 mm, respectively, for the averaged DSC, precision, recall, HD95, and ASD.

CONCLUSION

The proposed algorithm can be used to segment skeletal muscles at the L3 level in either the plain or enhanced low-dose CT images.

Unsupervised and Self-supervised Learning in Low-Dose Computed Tomography Denoising: Insights from Training Strategies

In recent years, X-ray low-dose computed tomography (LDCT) has garnered widespread attention due to its significant reduction in the risk of patient radiation exposure. However, LDCT images often contain a substantial amount of noises, adversely affecting diagnostic quality. To mitigate this, a plethora of LDCT denoising methods have been proposed. Among them, deep learning (DL) approaches have emerged as the most effective, due to their robust feature extraction capabilities. Yet, the prevalent use of supervised training paradigms is often impractical due to the challenges in acquiring low-dose and normal-dose CT pairs in clinical settings. Consequently, unsupervised and self-supervised deep learning methods have been introduced for LDCT denoising, showing considerable potential for clinical applications. These methods' efficacy hinges on training strategies. Notably, there appears to be no comprehensive reviews of these strategies. Our review aims to address this gap, offering insights and guidance for researchers and practitioners. Based on training strategies, we categorize the LDCT methods into six groups: (i) cycle consistency-based, (ii) score matching-based, (iii) statistical characteristics of noise-based, (iv) similarity-based, (v) LDCT synthesis model-based, and (vi) hybrid methods. For each category, we delve into the theoretical underpinnings, training strategies, strengths, and limitations. In addition, we also summarize the open source codes of the reviewed methods. Finally, the review concludes with a discussion on open issues and future research directions.

Uncertainty Estimation and Out-of-Distribution Detection for Deep Learning-Based Image Reconstruction Using the Local Lipschitz

Accurate image reconstruction is at the heart of diagnostics in medical imaging. Supervised deep learning-based approaches have been investigated for solving inverse problems including image reconstruction. However, these trained models encounter unseen data distributions that are widely shifted from training data during deployment. Therefore, it is essential to assess whether a given input falls within the training data distribution. Current uncertainty estimation approaches focus on providing an uncertainty map to radiologists, rather than assessing the training distribution fit. In this work, we propose a method based on the local Lipschitz metric to distinguish out-of-distribution images from in-distribution with an area under the curve of 99.94% for True Positive Rate versus False Positive Rate. We demonstrate a very strong relationship between the local Lipschitz value and mean absolute error (MAE), supported by a Spearman's rank correlation coefficient of 0.8475, to determine an uncertainty estimation threshold for optimal performance. Through the identification of false positives, we demonstrate the local Lipschitz and MAE relationship can guide data augmentation and reduce uncertainty. Our study was validated using the AUTOMAP architecture for sensor-to-image Magnetic Resonance Imaging (MRI) reconstruction. We demonstrate our approach outperforms baseline techniques of Monte-Carlo dropout and deep ensembles as well as the state-of-the-art Mean Variance Estimation network approach. We expand our application scope to MRI denoising and Computed Tomography sparse-to-full view reconstructions using UNET architectures. We show our approach is applicable to various architectures and applications, especially in medical imaging, where preserving diagnostic accuracy of reconstructed images remains paramount.

Continual medical image denoising based on triplet neural networks collaboration

BACKGROUND

When multiple tasks are learned consecutively, the old model parameters may be overwritten by the new data, resulting in the phenomenon that the new task is learned and the old task is forgotten, which leads to catastrophic forgetting. Moreover, continual learning has no mature solution for image denoising tasks.

METHODS

Therefore, in order to solve the problem of catastrophic forgetting caused by learning multiple denoising tasks, we propose a Triplet Neural-networks Collaboration-continuity DeNosing (TNCDN) model. Use triplet neural networks to update each other cooperatively. The knowledge from two denoising networks that maintain continual learning capability is transferred to the main-denoising network. The main-denoising network has new knowledge and can consolidate old knowledge. A co-training mechanism is designed. The main-denoising network updates the other two denoising networks with different thresholds to maintain memory reinforcement capability and knowledge extension capability.

RESULTS

The experimental results show that our method effectively alleviates catastrophic forgetting. In GS, CT and ADNI datasets, compared with ANCL, the TNCDN(PromptIR) method reduced the average degree of forgetting on the evaluation index PSNR by 2.38 (39%) and RMSE by 1.63 (55%).

CONCLUSION

This study aims to solve the problem of catastrophic forgetting caused by learning multiple denoising tasks. Although the experimental results are promising, extending the basic denoising model to more data sets and tasks will enhance its application. Nevertheless, this study is a starting point, which can provide reference and support for the further development of continuous learning image denoising task.

Dual-channel end-to-end network with prior knowledge embedding for improving spatial resolution of magnetic particle imaging

Magnetic particle imaging (MPI) is an emerging non-invasive medical imaging tomography technology based on magnetic particles, with excellent imaging depth penetration, high sensitivity and contrast. Spatial resolution and signal-to-noise ratio (SNR) are key performance metrics for evaluating MPI, which are directly influenced by the gradient of the selection field (SF). Increasing the SF gradient can improve the spatial resolution of MPI, but will lead to a decrease in SNR. Deep learning (DL) methods may enable obtaining high-resolution images from low-resolution images to improve the MPI resolution under low gradient conditions. However, existing DL methods overlook the physical procedures contributing to the blurring of MPI images, resulting in low interpretability and hindering breakthroughs in resolution. To address this issue, we propose a dual-channel end-to-end network with prior knowledge embedding for MPI (DENPK-MPI) to effectively establish a latent mapping between low-gradient and high-gradient images, thus improving MPI resolution without compromising SNR. By seamlessly integrating MPI PSF with DL paradigm, DENPK-MPI leads to a significant improvement in spatial resolution performance. Simulation, phantom, and in vivo MPI experiments have collectively confirmed that our method can improve the resolution of low-gradient MPI images without sacrificing SNR, resulting in a decrease in full width at half maximum by 14.8%-23.8 %, and the accuracy of image reconstruction is 18.2 %-27.3 % higher than other DL methods. In conclusion, we propose a DL method that incorporates MPI prior knowledge, which can improve the spatial resolution of MPI without compromising SNR and possess improved biomedical application.

Weakly supervised low-dose computed tomography denoising based on generative adversarial networks

Background

Low-dose computed tomography (LDCT) is a diagnostic imaging technique designed to minimize radiation exposure to the patient. However, this reduction in radiation may compromise computed tomography (CT) image quality, adversely impacting clinical diagnoses. Various advanced LDCT methods have emerged to mitigate this challenge, relying on well-matched LDCT and normal-dose CT (NDCT) image pairs for training. Nevertheless, these methods often face difficulties in distinguishing image details from nonuniformly distributed noise, limiting their denoising efficacy. Additionally, acquiring suitably paired datasets in the medical domain poses challenges, further constraining their applicability. Hence, the objective of this study was to develop an innovative denoising framework for LDCT images employing unpaired data.

Methods

In this paper, we propose a LDCT denoising network (DNCNN) that alleviates the need for aligning LDCT and NDCT images. Our approach employs generative adversarial networks (GANs) to learn and model the noise present in LDCT images, establishing a mapping from the pseudo-LDCT to the actual NDCT domain without the need for paired CT images.

Results

Within the domain of weakly supervised methods, our proposed model exhibited superior objective metrics on the simulated dataset when compared to CycleGAN and selective kernel-based cycle-consistent GAN (SKFCycleGAN): the peak signal-to-noise ratio (PSNR) was 43.9441, the structural similarity index measure (SSIM) was 0.9660, and the visual information fidelity (VIF) was 0.7707. In the clinical dataset, we conducted a visual effect analysis by observing various tissues through different observation windows. Our proposed method achieved a no-reference structural sharpness (NRSS) value of 0.6171, which was closest to that of the NDCT images (NRSS =0.6049), demonstrating its superiority over other denoising techniques in preserving details, maintaining structural integrity, and enhancing edge contrast.

Conclusions

Through extensive experiments on both simulated and clinical datasets, we demonstrated the superior efficacy of our proposed method in terms of denoising quality and quantity. Our method exhibits superiority over both supervised techniques, including block-matching and 3D filtering (BM3D), residual encoder-decoder convolutional neural network (RED-CNN), and Wasserstein generative adversarial network-VGG (WGAN-VGG), and over weakly supervised approaches, including CycleGAN and SKFCycleGAN.

Structure-aware diffusion for low-dose CT imaging

Reducing the radiation dose leads to the x-ray computed tomography (CT) images suffering from heavy noise and artifacts, which inevitably interferes with the subsequent clinic diagnostic and analysis. Leading works have explored diffusion models for low-dose CT imaging to avoid the structure degeneration and blurring effects of previous deep denoising models. However, most of them always begin their generative processes with Gaussian noise, which has little or no structure priors of the clean data distribution, thereby leading to long-time inference and unpleasant reconstruction quality. To alleviate these problems, this paper presents a Structure-Aware Diffusion model (SAD), an end-to-end self-guided learning framework for high-fidelity CT image reconstruction. First, SAD builds a nonlinear diffusion bridge between clean and degraded data distributions, which could directly learn the implicit physical degradation prior from observed measurements. Second, SAD integrates the prompt learning mechanism and implicit neural representation into the diffusion process, where rich and diverse structure representations extracted by degraded inputs are exploited as prompts, which provides global and local structure priors, to guide CT image reconstruction. Finally, we devise an efficient self-guided diffusion architecture using an iterative updated strategy, which further refines structural prompts during each generative step to drive finer image reconstruction. Extensive experiments on AAPM-Mayo and LoDoPaB-CT datasets demonstrate that our SAD could achieve superior performance in terms of noise removal, structure preservation, and blind-dose generalization, with few generative steps, even one step only.

DeCoGAN: MVCT image denoising via coupled generative adversarial network

Objective.In helical tomotherapy, image-guided radiotherapy employs megavoltage computed tomography (MVCT) for precise targeting. However, the high voltage of megavoltage radiation introduces substantial noise, significantly compromising MVCT image clarity. This study aims to enhance MVCT image quality using a deep learning-based denoising method.Approach.We propose an unpaired MVCT denoising network using a coupled generative adversarial network framework (DeCoGAN). Our approach assumes that a universal latent code within a shared latent space can reconstruct any given pair of images. By employing an encoder, we enforce this shared-latent space constraint, facilitating the conversion of low-quality (noisy) MVCT images into high-quality (denoised) counterparts. The network learns the joint distribution of images from both domains by leveraging samples from their respective marginal distributions, enhanced by adversarial training for effective denoising.Main Results.Compared to an analytical algorithm (BM3D) and three deep learning-based methods (RED-CNN, WGAN-VGG and CycleGAN), the proposed method excels in preserving image details and enhancing human visual perception by removing most noise and retaining structural features. Quantitative analysis demonstrates that our method achieves the highest peak signal-to-noise ratio and Structural Similarity Index Measurement values, indicating superior denoising performance.Significance.The proposed DeCoGAN method shows remarkable MVCT denoising performance, making it a promising tool in the field of radiation therapy.

DDT-Net: Dose-Agnostic Dual-Task Transfer Network for Simultaneous Low-Dose CT Denoising and Simulation

Deep learning (DL) algorithms have achieved unprecedented success in low-dose CT (LDCT) imaging and are expected to be a new generation of CT reconstruction technology. However, most DL-based denoising models often lack the ability to generalize to unseen dose data. Moreover, most simulation tools for LDCT typically operate on proprietary projection data, which is generally not accessible without an established collaboration with CT manufacturers. To alleviate these issues, in this work, we propose a dose-agnostic dual-task transfer network, termed DDT-Net, for simultaneous LDCT denoising and simulation. Concretely, the dual-task learning module is constructed to integrate the LDCT denoising and simulation tasks into a unified optimization framework by learning the joint distribution of LDCT and NDCT data. We approximate the joint distribution of continuous dose level data by training DDT-Net with discrete dose data, which can be generalized to denoising and simulation of unseen dose data. In particular, the mixed-dose training strategy adopted by DDT-Net can promote the denoising performance of lower-dose data. The paired dataset simulated by DDT-Net can be used for data augmentation to further restore the tissue texture of LDCT images. Experimental results on synthetic data and clinical data show that the proposed DDT-Net outperforms competing methods in terms of denoising and generalization performance at unseen dose data, and it also provides a simulation tool that can quickly simulate realistic LDCT images at arbitrary dose levels.

Convolutional neural networks combined with conventional filtering to semantically segment plant roots in rapidly scanned X-ray computed tomography volumes with high noise levels

BACKGROUND

X-ray computed tomography (CT) is a powerful tool for measuring plant root growth in soil. However, a rapid scan with larger pots, which is required for throughput-prioritized crop breeding, results in high noise levels, low resolution, and blurred root segments in the CT volumes. Moreover, while plant root segmentation is essential for root quantification, detailed conditional studies on segmenting noisy root segments are scarce. The present study aimed to investigate the effects of scanning time and deep learning-based restoration of image quality on semantic segmentation of blurry rice (Oryza sativa) root segments in CT volumes.

RESULTS

VoxResNet, a convolutional neural network-based voxel-wise residual network, was used as the segmentation model. The training efficiency of the model was compared using CT volumes obtained at scan times of 33, 66, 150, 300, and 600 s. The learning efficiencies of the samples were similar, except for scan times of 33 and 66 s. In addition, The noise levels of predicted volumes differd among scanning conditions, indicating that the noise level of a scan time ≥ 150 s does not affect the model training efficiency. Conventional filtering methods, such as median filtering and edge detection, increased the training efficiency by approximately 10% under any conditions. However, the training efficiency of 33 and 66 s-scanned samples remained relatively low. We concluded that scan time must be at least 150 s to not affect segmentation. Finally, we constructed a semantic segmentation model for 150 s-scanned CT volumes, for which the Dice loss reached 0.093. This model could not predict the lateral roots, which were not included in the training data. This limitation will be addressed by preparing appropriate training data.

CONCLUSIONS

A semantic segmentation model can be constructed even with rapidly scanned CT volumes with high noise levels. Given that scanning times ≥ 150 s did not affect the segmentation results, this technique holds promise for rapid and low-dose scanning. This study offers insights into images other than CT volumes with high noise levels that are challenging to determine when annotating.

LIT-Former: Linking In-Plane and Through-Plane Transformers for Simultaneous CT Image Denoising and Deblurring

This paper studies 3D low-dose computed tomography (CT) imaging. Although various deep learning methods were developed in this context, typically they focus on 2D images and perform denoising due to low-dose and deblurring for super-resolution separately. Up to date, little work was done for simultaneous in-plane denoising and through-plane deblurring, which is important to obtain high-quality 3D CT images with lower radiation and faster imaging speed. For this task, a straightforward method is to directly train an end-to-end 3D network. However, it demands much more training data and expensive computational costs. Here, we propose to link in-plane and through-plane transformers for simultaneous in-plane denoising and through-plane deblurring, termed as LIT-Former, which can efficiently synergize in-plane and through-plane sub-tasks for 3D CT imaging and enjoy the advantages of both convolution and transformer networks. LIT-Former has two novel designs: efficient multi-head self-attention modules (eMSM) and efficient convolutional feed-forward networks (eCFN). First, eMSM integrates in-plane 2D self-attention and through-plane 1D self-attention to efficiently capture global interactions of 3D self-attention, the core unit of transformer networks. Second, eCFN integrates 2D convolution and 1D convolution to extract local information of 3D convolution in the same fashion. As a result, the proposed LIT-Former synergizes these two sub-tasks, significantly reducing the computational complexity as compared to 3D counterparts and enabling rapid convergence. Extensive experimental results on simulated and clinical datasets demonstrate superior performance over state-of-the-art models. The source code is made available at https://github.com/hao1635/LIT-Former.

Noise-Generating and Imaging Mechanism Inspired Implicit Regularization Learning Network for Low Dose CT Reconstrution

Low-dose computed tomography (LDCT) helps to reduce radiation risks in CT scanning while maintaining image quality, which involves a consistent pursuit of lower incident rays and higher reconstruction performance. Although deep learning approaches have achieved encouraging success in LDCT reconstruction, most of them treat the task as a general inverse problem in either the image domain or the dual (sinogram and image) domains. Such frameworks have not considered the original noise generation of the projection data and suffer from limited performance improvement for the LDCT task. In this paper, we propose a novel reconstruction model based on noise-generating and imaging mechanism in full-domain, which fully considers the statistical properties of intrinsic noises in LDCT and prior information in sinogram and image domains. To solve the model, we propose an optimization algorithm based on the proximal gradient technique. Specifically, we derive the approximate solutions of the integer programming problem on the projection data theoretically. Instead of hand-crafting the sinogram and image regularizers, we propose to unroll the optimization algorithm to be a deep network. The network implicitly learns the proximal operators of sinogram and image regularizers with two deep neural networks, providing a more interpretable and effective reconstruction procedure. Numerical results demonstrate our proposed method improvements of > 2.9 dB in peak signal to noise ratio, > 1.4% promotion in structural similarity metric, and > 9 HU decrements in root mean square error over current state-of-the-art LDCT methods.

Direct estimation of the noise power spectrum from patient data to generate synthesized CT noise for denoising network training

BACKGROUND

Developing a deep-learning network for denoising low-dose CT (LDCT) images necessitates paired computed tomography (CT) images acquired at different dose levels. However, it is challenging to obtain these images from the same patient.

PURPOSE

In this study, we introduce a novel approach to generate CT images at different dose levels.

METHODS

Our method involves the direct estimation of the quantum noise power spectrum (NPS) from patient CT images without the need for prior information. By modeling the anatomical NPS using a power-law function and estimating the quantum NPS from the measured NPS after removing the anatomical NPS, we create synthesized quantum noise by applying the estimated quantum NPS as a filter to random noise. By adding synthesized noise to CT images, synthesized CT images can be generated as if these are obtained at a lower dose. This leads to the generation of paired images at different dose levels for training denoising networks.

RESULTS

The proposed method accurately estimates the reference quantum NPS. The denoising network trained with paired data generated using synthesized quantum noise achieves denoising performance comparable to networks trained using Mayo Clinic data, as justified by the mean-squared-error (MSE), structural similarity index (SSIM)and peak signal-to-noise ratio (PSNR) scores.

CONCLUSIONS

This approach offers a promising solution for LDCT image denoising network development without the need for multiple scans of the same patient at different doses.

Re-UNet: a novel multi-scale reverse U-shape network architecture for low-dose CT image reconstruction

In recent years, the growing awareness of public health has brought attention to low-dose computed tomography (LDCT) scans. However, the CT image generated in this way contains a lot of noise or artifacts, which make increasing researchers to investigate methods to enhance image quality. The advancement of deep learning technology has provided researchers with novel approaches to enhance the quality of LDCT images. In the past, numerous studies based on convolutional neural networks (CNN) have yielded remarkable results in LDCT image reconstruction. Nonetheless, they all tend to continue to design new networks based on the fixed network architecture of UNet shape, which also leads to more and more complex networks. In this paper, we proposed a novel network model with a reverse U-shape architecture for the noise reduction in the LDCT image reconstruction task. In the model, we further designed a novel multi-scale feature extractor and edge enhancement module that yields a positive impact on CT images to exhibit strong structural characteristics. Evaluated on a public dataset, the experimental results demonstrate that the proposed model outperforms the compared algorithms based on traditional U-shaped architecture in terms of preserving texture details and reducing noise, as demonstrated by achieving the highest PSNR, SSIM and RMSE value. This study may shed light on the reverse U-shaped network architecture for CT image reconstruction, and could investigate the potential on other medical image processing.

A Review of deep learning methods for denoising of medical low-dose CT images

To prevent patients from being exposed to excess of radiation in CT imaging, the most common solution is to decrease the radiation dose by reducing the X-ray, and thus the quality of the resulting low-dose CT images (LDCT) is degraded, as evidenced by more noise and streaking artifacts. Therefore, it is important to maintain high quality CT image while effectively reducing radiation dose. In recent years, with the rapid development of deep learning technology, deep learning-based LDCT denoising methods have become quite popular because of their data-driven and high-performance features to achieve excellent denoising results. However, to our knowledge, no relevant article has so far comprehensively introduced and reviewed advanced deep learning denoising methods such as Transformer structures in LDCT denoising tasks. Therefore, based on the literatures related to LDCT image denoising published from year 2016-2023, and in particular from 2020 to 2023, this study presents a systematic survey of current situation, and challenges and future research directions in LDCT image denoising field. Four types of denoising networks are classified according to the network structure: CNN-based, Encoder-Decoder-based, GAN-based, and Transformer-based denoising networks, and each type of denoising network is described and summarized from the perspectives of structural features and denoising performances. Representative deep-learning denoising methods for LDCT are experimentally compared and analyzed. The study results show that CNN-based denoising methods capture image details efficiently through multi-level convolution operation, demonstrating superior denoising effects and adaptivity. Encoder-decoder networks with MSE loss, achieve outstanding results in objective metrics. GANs based methods, employing innovative generators and discriminators, obtain denoised images that exhibit perceptually a closeness to NDCT. Transformer-based methods have potential for improving denoising performances due to their powerful capability in capturing global information. Challenges and opportunities for deep learning based LDCT denoising are analyzed, and future directions are also presented.

Multi-kernel driven 3D convolutional neural network for automated detection of lung nodules in chest CT scans

The accurate position detection of lung nodules is crucial in early chest computed tomography (CT)-based lung cancer screening, which helps to improve the survival rate of patients. Deep learning methodologies have shown impressive feature extraction ability in the CT image analysis task, but it is still a challenge to develop a robust nodule detection model due to the salient morphological heterogeneity of nodules and complex surrounding environment. In this study, a multi-kernel driven 3D convolutional neural network (MK-3DCNN) is proposed for computerized nodule detection in CT scans. In the MK-3DCNN, a residual learning-based encoder-decoder architecture is introduced to employ the multi-layer features of the deep model. Considering the various nodule sizes and shapes, a multi-kernel joint learning block is developed to capture 3D multi-scale spatial information of nodule CT images, and this is conducive to improving nodule detection performance. Furthermore, a multi-mode mixed pooling strategy is designed to replace the conventional single-mode pooling manner, and it reasonably integrates the max pooling, average pooling, and center cropping pooling operations to obtain more comprehensive nodule descriptions from complicated CT images. Experimental results on the public dataset LUNA16 illustrate that the proposed MK-3DCNN method achieves more competitive nodule detection performance compared to some state-of-the-art algorithms. The results on our constructed clinical dataset CQUCH-LND indicate that the MK-3DCNN has a good prospect in clinical practice.

CT image denoising methods for image quality improvement and radiation dose reduction

With the ever-increasing use of computed tomography (CT), concerns about its radiation dose have become a significant public issue. To address the need for radiation dose reduction, CT denoising methods have been widely investigated and applied in low-dose CT images. Numerous noise reduction algorithms have emerged, such as iterative reconstruction and most recently, deep learning (DL)-based approaches. Given the rapid advancements in Artificial Intelligence techniques, we recognize the need for a comprehensive review that emphasizes the most recently developed methods. Hence, we have performed a thorough analysis of existing literature to provide such a review. Beyond directly comparing the performance, we focus on pivotal aspects, including model training, validation, testing, generalizability, vulnerability, and evaluation methods. This review is expected to raise awareness of the various facets involved in CT image denoising and the specific challenges in developing DL-based models.

Advancing equitable and personalized cancer care: Novel applications and priorities of artificial intelligence for fairness and inclusivity in the patient care workflow

Patient care workflows are highly multimodal and intertwined: the intersection of data outputs provided from different disciplines and in different formats remains one of the main challenges of modern oncology. Artificial Intelligence (AI) has the potential to revolutionize the current clinical practice of oncology owing to advancements in digitalization, database expansion, computational technologies, and algorithmic innovations that facilitate discernment of complex relationships in multimodal data. Within oncology, radiation therapy (RT) represents an increasingly complex working procedure, involving many labor-intensive and operator-dependent tasks. In this context, AI has gained momentum as a powerful tool to standardize treatment performance and reduce inter-observer variability in a time-efficient manner. This review explores the hurdles associated with the development, implementation, and maintenance of AI platforms and highlights current measures in place to address them. In examining AI's role in oncology workflows, we underscore that a thorough and critical consideration of these challenges is the only way to ensure equitable and unbiased care delivery, ultimately serving patients' survival and quality of life.

A two-stage deep-learning framework for CT denoising based on a clinically structure-unaligned paired data set

Background

In low-dose computed tomography (LDCT) lung cancer screening, soft tissue is hardly appreciable due to high noise levels. While deep learning-based LDCT denoising methods have shown promise, they typically rely on structurally aligned synthesized paired data, which lack consideration of the clinical reality that there are no aligned LDCT and normal-dose CT (NDCT) images available. This study introduces an LDCT denoising method using clinically structure-unaligned but paired data sets (LDCT and NDCT scans from the same patients) to improve lesion detection during LDCT lung cancer screening.

Methods

A cohort of 64 patients undergoing both LDCT and NDCT was randomly divided into training (n=46) and testing (n=18) sets. A two-stage training approach was adopted. First, Gaussian noise was added to NDCT data to create simulated LDCT data for generator training. Then, the model was trained on a clinically structure-unaligned paired data set using a Wasserstein generative adversarial network (WGAN) framework with the initial generator weights obtained during the first stage of training. An attention mechanism was also incorporated into the network.

Results

Validated on a clinical CT data set, our proposed method outperformed other available methods [CycleGAN, Pixel2Pixel, block-matching and three-dimensional filtering (BM3D)] in noise removal and detail retention tasks in terms of the peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and root mean square error (RMSE) metrics. Compared with the results produced by BM3D, our method yielded an average improvement of approximately 7% in terms of the three evaluation indicators. The probability density profile of the denoised CT output produced using our method best fit the reference NDCT scan. Additionally, our two-stage model outperformed the one-stage WGAN-based model in both objective and subjective evaluations, further demonstrating the higher effectiveness of our two-stage training approach.

Conclusions

The proposed method performed the best in removing noise from LDCT scans and exhibited good detail retention, which could potentially enhance the lesion detection and characterization effects obtained for soft tissues in the scanning scope of LDCT lung cancer screening.

Image Quality Improvement of Low-dose Abdominal CT using Deep Learning Image Reconstruction Compared with the Second Generation Iterative Reconstruction

BACKGROUND

Whether deep learning-based CT reconstruction could improve lesion conspicuity on abdominal CT when the radiation dose is reduced is controversial.

OBJECTIVES

To determine whether DLIR can provide better image quality and reduce radiation dose in contrast-enhanced abdominal CT compared with the second generation of adaptive statistical iterative reconstruction (ASiR-V).

AIMS

This study aims to determine whether deep-learning image reconstruction (DLIR) can improve image quality.

METHOD

In this retrospective study, a total of 102 patients were included, who underwent abdominal CT using a DLIR-equipped 256-row scanner and routine CT of the same protocol on the same vendor's 64-row scanner within four months. The CT data from the 256-row scanner were reconstructed into ASiR-V with three blending levels (AV30, AV60, and AV100), and DLIR images with three strength levels (DLIR-L, DLIR-M, and DLIR-H). The routine CT data were reconstructed into AV30, AV60, and AV100. The contrast-to-noise ratio (CNR) of the liver, overall image quality, subjective noise, lesion conspicuity, and plasticity in the portal venous phase (PVP) of ASiR-V from both scanners and DLIR were compared.

RESULTS

The mean effective radiation dose of PVP of the 256-row scanner was significantly lower than that of the routine CT (6.3±2.0 mSv vs. 2.4±0.6 mSv; p< 0.001). The mean CNR, image quality, subjective noise, and lesion conspicuity of ASiR-V images of the 256-row scanner were significantly lower than those of ASiR-V images at the same blending factor of routine CT, but significantly improved with DLIR algorithms. DLIR-H showed higher CNR, better image quality, and subjective noise than AV30 from routine CT, whereas plasticity was significantly better for AV30.

CONCLUSION

DLIR can be used for improving image quality and reducing radiation dose in abdominal CT, compared with ASIR-V.

StruNet: Perceptual and low-rank regularized transformer for medical image denoising

BACKGROUND

Various types of noise artifacts inevitably exist in some medical imaging modalities due to limitations of imaging techniques, which impair either clinical diagnosis or subsequent analysis. Recently, deep learning approaches have been rapidly developed and applied on medical images for noise removal or image quality enhancement. Nevertheless, due to complexity and diversity of noise distribution representations in different medical imaging modalities, most of the existing deep learning frameworks are incapable to flexibly remove noise artifacts while retaining detailed information. As a result, it remains challenging to design an effective and unified medical image denoising method that will work across a variety of noise artifacts for different imaging modalities without requiring specialized knowledge in performing the task.

PURPOSE

In this paper, we propose a novel encoder-decoder architecture called Swin transformer-based residual u-shape Network (StruNet), for medical image denoising.

METHODS

Our StruNet adopts a well-designed block as the backbone of the encoder-decoder architecture, which integrates Swin Transformer modules with residual block in parallel connection. Swin Transformer modules could effectively learn hierarchical representations of noise artifacts via self-attention mechanism in non-overlapping shifted windows and cross-window connection, while residual block is advantageous to compensate loss of detailed information via shortcut connection. Furthermore, perceptual loss and low-rank regularization are incorporated into loss function respectively in order to constrain the denoising results on feature-level consistency and low-rank characteristics.

RESULTS

To evaluate the performance of the proposed method, we have conducted experiments on three medical imaging modalities including computed tomography (CT), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).

CONCLUSIONS

The results demonstrate that the proposed architecture yields a promising performance of suppressing multiform noise artifacts existing in different imaging modalities.

Unsharp Structure Guided Filtering for Self-Supervised Low-Dose CT Imaging

Low-dose computed tomography (LDCT) imaging faces great challenges. Although supervised learning has revealed great potential, it requires sufficient and high-quality references for network training. Therefore, existing deep learning methods have been sparingly applied in clinical practice. To this end, this paper presents a novel Unsharp Structure Guided Filtering (USGF) method, which can reconstruct high-quality CT images directly from low-dose projections without clean references. Specifically, we first employ low-pass filters to estimate the structure priors from the input LDCT images. Then, inspired by classical structure transfer techniques, deep convolutional networks are adopted to implement our imaging method which combines guided filtering and structure transfer. Finally, the structure priors serve as the guidance images to alleviate over-smoothing, as they can transfer specific structural characteristics to the generated images. Furthermore, we incorporate traditional FBP algorithms into self-supervised training to enable the transformation of projection domain data to the image domain. Extensive comparisons and analyses on three datasets demonstrate that the proposed USGF has achieved superior performance in terms of noise suppression and edge preservation, and could have a significant impact on LDCT imaging in the future.

[Imaging for urolithiasis]

The substantial reduction of radiation exposure using (ultra-)low dose programs in native computed tomographic imaging has led to considerable changes in imaging diagnostics and treatment planning in urolithiasis in recent years. In addition, especially in Germany, ultrasound diagnostics is highly available in terms of equipment and with increasing expertise. This can largely replace the previous radiation-associated procedures in emergency and follow-up diagnostics, but also in intraoperative imaging, e.g., in percutaneous stone therapy (intraoperative fluoroscopy). This is reflected in the international guidelines, which recommend these two modalities as first-line diagnostics in all areas mentioned. Continuous technical development enables ever higher resolution imaging and thus improved diagnostics with high sensitivity and specificity. This also enables reliable imaging of particularly vulnerable patient groups, such as children or pregnant women. In addition, methods from the field of artificial intelligence (AI; machine learning, deep learning) are increasingly being used for automated stone detection and stone characterization including its composition. Furthermore, AI models can provide prognosis models as well as individually tailored treatment, follow-up, and prophyaxis. This will enable further personalization of diagnostics and therapy in the field of urolithiasis.

Self-supervised denoising of projection data for low-dose cone-beam CT

BACKGROUND

Convolutional neural networks (CNNs) have shown promising results in image denoising tasks. While most existing CNN-based methods depend on supervised learning by directly mapping noisy inputs to clean targets, high-quality references are often unavailable for interventional radiology such as cone-beam computed tomography (CBCT).

PURPOSE

In this paper, we propose a novel self-supervised learning method that reduces noise in projections acquired by ordinary CBCT scans.

METHODS

With a network that partially blinds input, we are able to train the denoising model by mapping the partially blinded projections to the original projections. Additionally, we incorporate noise-to-noise learning into the self-supervised learning by mapping the adjacent projections to the original projections. With standard image reconstruction methods such as FDK-type algorithms, we can reconstruct high-quality CBCT images from the projections denoised by our projection-domain denoising method.

RESULTS

In the head phantom study, we measure peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) values of the proposed method along with the other denoising methods and uncorrected low-dose CBCT data for a quantitative comparison both in projection and image domains. The PSNR and SSIM values of our self-supervised denoising approach are 27.08 and 0.839, whereas those of uncorrected CBCT images are 15.68 and 0.103, respectively. In the retrospective study, we assess the quality of interventional patient CBCT images to evaluate the projection-domain and image-domain denoising methods. Both qualitative and quantitative results indicate that our approach can effectively produce high-quality CBCT images with low-dose projections in the absence of duplicate clean or noisy references.

CONCLUSIONS

Our self-supervised learning strategy is capable of restoring anatomical information while efficiently removing noise in CBCT projection data.

HCformer: Hybrid CNN-Transformer for LDCT Image Denoising

Low-dose computed tomography (LDCT) is an effective way to reduce radiation exposure for patients. However, it will increase the noise of reconstructed CT images and affect the precision of clinical diagnosis. The majority of the current deep learning-based denoising methods are built on convolutional neural networks (CNNs), which concentrate on local information and have little capacity for multiple structures modeling. Transformer structures are capable of computing each pixel's response on a global scale, but their extensive computation requirements prevent them from being widely used in medical image processing. To reduce the impact of LDCT scans on patients, this paper aims to develop an image post-processing method by combining CNN and Transformer structures. This method can obtain a high-quality images from LDCT. A hybrid CNN-Transformer (HCformer) codec network model is proposed for LDCT image denoising. A neighborhood feature enhancement (NEF) module is designed to introduce the local information into the Transformer's operation, and the representation of adjacent pixel information in the LDCT image denoising task is increased. The shifting window method is utilized to lower the computational complexity of the network model and overcome the problems that come with computing the MSA (Multi-head self-attention) process in a fixed window. Meanwhile, W/SW-MSA (Windows/Shifted window Multi-head self-attention) is alternately used in two layers of the Transformer to gain the information interaction between various Transformer layers. This approach can successfully decrease the Transformer's overall computational cost. The AAPM 2016 LDCT grand challenge dataset is employed for ablation and comparison experiments to demonstrate the viability of the proposed LDCT denoising method. Per the experimental findings, HCformer can increase the image quality metrics SSIM, HuRMSE and FSIM from 0.8017, 34.1898, and 0.6885 to 0.8507, 17.7213, and 0.7247, respectively. Additionally, the proposed HCformer algorithm will preserves image details while it reduces noise. In this paper, an HCformer structure is proposed based on deep learning and evaluated by using the AAPM LDCT dataset. Both the qualitative and quantitative comparison results confirm that the proposed HCformer outperforms other methods. The contribution of each component of the HCformer is also confirmed by the ablation experiments. HCformer can combine the advantages of CNN and Transformer, and it has great potential for LDCT image denoising and other tasks.

Transformer With Double Enhancement for Low-Dose CT Denoising

Increasingly serious health problems have made the usage of computed tomography surge. Therefore, algorithms for processing CT images are becoming more and more abundant. These algorithms can lessen the harm of cumulative radiation in CT technology for the patient while eliminating the noise of image caused by dose reduction. However, the mainstream CNN-based algorithms are inefficient when dealing with features in broad regions. Inspired by the large receptive field of transformer framework, this paper designs an end-to-end low-dose CT (LDCT) denoising network based on the transformer. The overall network contains a main branch and dual side branches. Specifically, the overlapping-free window-based self-attention transformer block is adopted on the main branch to realize image denoising. On the dual side branches, we propose double enhancement module to enrich edge, texture, and context information of LDCT images. Meanwhile, the receptive field of network is further enlarged after processing, which is helpful for building model's long-range dependencies. The outputs of the side branches are concatenated for enhancing information and generating high-quality CT images. In addition, to better train the network, we introduce a compound loss function including mean squared error (MSE), multi-scale perceptual (MSP), and Sobel-L1 (SL) to make the denoised image closer to the targeted norm-dose CT (NDCT) image. Lastly, we conducted experiments on two clinical datasets including abdomen, head, and chest LDCT images with 25%, 25%, and 10% of the full dose, respectively. The experimental results demonstrated that the proposed DEformer achieved better denoising performance than the existing algorithms.

Clinical applications of artificial intelligence in radiology

The rapid growth of medical imaging has placed increasing demands on radiologists. In this scenario, artificial intelligence (AI) has become an attractive partner, one that may complement case interpretation and may aid in various non-interpretive aspects of the work in the radiological clinic. In this review, we discuss interpretative and non-interpretative uses of AI in the clinical practice, as well as report on the barriers to AI's adoption in the clinic. We show that AI currently has a modest to moderate penetration in the clinical practice, with many radiologists still being unconvinced of its value and the return on its investment. Moreover, we discuss the radiologists' liabilities regarding the AI decisions, and explain how we currently do not have regulation to guide the implementation of explainable AI or of self-learning algorithms.

Unsupervised learning-based dual-domain method for low-dose CT denoising

Objective. Low-dose CT (LDCT) is an important research topic in the field of CT imaging because of its ability to reduce radiation damage in clinical diagnosis. In recent years, deep learning techniques have been widely applied in LDCT imaging and a large number of denoising methods have been proposed. However, One major challenge of supervised deep learning-based methods is the exactly geometric pairing of datasets with different doses. Therefore, the aim of this study is to develop an unsupervised learning-based LDCT imaging method to address the aforementioned challenges.Approach. In this paper, we propose an unsupervised learning-based dual-domain method for LDCT denoising, which consists of two stages: the first stage is projection domain denoising, in which the unsupervised learning method Noise2Self is applied to denoise the projection data with statistically independent and zero-mean noise. The second stage is an iterative enhancement approach, which combines the prior information obtained from the generative model with an iterative reconstruction algorithm to enhance the details of the reconstructed image.Main results. Experimental results show that our proposed method outperforms the comparison method in terms of denoising effect. Particularly, in terms of SSIM, the denoised results obtained using our method achieve the highest SSIM.Significance. In conclusion, our unsupervised learning-based method can be a promising alternative to the traditional supervised methods for LDCT imaging, especially when the availability of the labeled datasets is limited.

MLNAN: Multi-level noise-aware network for low-dose CT imaging implemented with constrained cycle Wasserstein generative adversarial networks

Low-dose CT techniques attempt to minimize the radiation exposure of patients by estimating the high-resolution normal-dose CT images to reduce the risk of radiation-induced cancer. In recent years, many deep learning methods have been proposed to solve this problem by building a mapping function between low-dose CT images and their high-dose counterparts. However, most of these methods ignore the effect of different radiation doses on the final CT images, which results in large differences in the intensity of the noise observable in CT images. What'more, the noise intensity of low-dose CT images exists significantly differences under different medical devices manufacturers. In this paper, we propose a multi-level noise-aware network (MLNAN) implemented with constrained cycle Wasserstein generative adversarial networks to recovery the low-dose CT images under uncertain noise levels. Particularly, the noise-level classification is predicted and reused as a prior pattern in generator networks. Moreover, the discriminator network introduces noise-level determination. Under two dose-reduction strategies, experiments to evaluate the performance of proposed method are conducted on two datasets, including the simulated clinical AAPM challenge datasets and commercial CT datasets from United Imaging Healthcare (UIH). The experimental results illustrate the effectiveness of our proposed method in terms of noise suppression and structural detail preservation compared with several other deep-learning based methods. Ablation studies validate the effectiveness of the individual components regarding the afforded performance improvement. Further research for practical clinical applications and other medical modalities is required in future works.

Computed Tomography of the Head : A Systematic Review on Acquisition and Reconstruction Techniques to Reduce Radiation Dose

In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.

Self-adaption and texture generation: A hybrid loss function for low-dose CT denoising

BACKGROUND

Deep learning has been successfully applied to low-dose CT (LDCT) denoising. But the training of the model is very dependent on an appropriate loss function. Existing denoising models often use per-pixel loss, including mean abs error (MAE) and mean square error (MSE). This ignores the difference in denoising difficulty between different regions of the CT images and leads to the loss of large texture information in the generated image.

PURPOSE

In this paper, we propose a new hybrid loss function that adapts to the noise in different regions of CT images to balance the denoising difficulty and preserve texture details, thus acquiring CT images with high-quality diagnostic value using LDCT images, providing strong support for condition diagnosis.

METHODS

We propose a hybrid loss function consisting of weighted patch loss (WPLoss) and high-frequency information loss (HFLoss). To enhance the model's denoising ability of the local areas which are difficult to denoise, we improve the MAE to obtain WPLoss. After the generated image and the target image are divided into several patches, the loss weight of each patch is adaptively and dynamically adjusted according to its loss ratio. In addition, considering that texture details are contained in the high-frequency information of the image, we use HFLoss to calculate the difference between CT images in the high-frequency information part.

RESULTS

Our hybrid loss function improves the denoising performance of several models in the experiment, and obtains a higher peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM). Moreover, through visual inspection of the generated results of the comparison experiment, the proposed hybrid function can effectively suppress noise and retain image details.

CONCLUSIONS

We propose a hybrid loss function for LDCT image denoising, which has good interpretation properties and can improve the denoising performance of existing models. And the validation results of multiple models using different datasets show that it has good generalization ability. By using this loss function, high-quality CT images with low radiation are achieved, which can avoid the hazards caused by radiation and ensure the disease diagnosis for patients.

Adaptive-weighted high order TV algorithm for sparse-view CT reconstruction

BACKGROUND

With the development of low-dose computed tomography (CT), incomplete data reconstruction has been widely concerned. The total variation (TV) minimization algorithm can accurately reconstruct images from sparse or noisy data.

PURPOSE

However, the traditional TV algorithm ignores the direction of structures in images, leading to the loss of edge information and block artifacts when the object is not piecewise constant. Since the anisotropic information can facilitate preserving the edge and detail information in images, we aim to improve the TV algorithm in terms of reconstruction accuracy via this approach.

METHODS

In this paper, we propose an adaptive-weighted high order total variation (awHOTV) algorithm. We construct the second order TV-norm using the second order gradient, adapt the anisotropic edge property between neighboring image pixels, adjust the local image-intensity gradient to keep edge information, and design the corresponding Chambolle-Pock (CP) solving algorithm. Implementing the proposed algorithm, comprehensive studies are conducted in the ideal projection data experiment where the Structural similarity (SSIM), Root Mean Square Error (RMSE), Contrast to noise ratio (CNR), and modulation transform function (MTF) curves are utilized to evaluate the quality of reconstructed images in statism, structure, spatial resolution, and contrast, respectively. In the noisy data experiment, we further use the noise power spectrum (NPS) curve to evaluate the reconstructed images and compare it with other three algorithms.

RESULTS

We use the 2D slice in the XCAT phantom, 2D slice in TCIA Challenge data and FORBILD phantom as simulation phantoms and use real bird data for real verification. The results show that, compared with the traditional TV and FBP algorithms, the awHOTV has better performance in terms of RMSE, SSIM, and Pearson correlation coefficient (PCC) under the projected data with different sparsity. In addition, the awHOTV algorithm is robust against the noise of different intensities.

CONCLUSIONS

The proposed awHOTV method can reconstruct the images with high accuracy under sparse or noisy data. The awHOTV solves the strip artifacts caused by sparse data in the FBP method. Compared with the TV method, the awHOTV can effectively suppress block artifacts and has good detail protection ability.

Impact of loss functions on the performance of a deep neural network designed to restore low-dose digital mammography

Digital mammography is currently the most common imaging tool for breast cancer screening. Although the benefits of using digital mammography for cancer screening outweigh the risks associated with the x-ray exposure, the radiation dose must be kept as low as possible while maintaining the diagnostic utility of the generated images, thus minimizing patient risks. Many studies investigated the feasibility of dose reduction by restoring low-dose images using deep neural networks. In these cases, choosing the appropriate training database and loss function is crucial and impacts the quality of the results. In this work, we used a standard residual network (ResNet) to restore low-dose digital mammography images and evaluated the performance of several loss functions. For training purposes, we extracted 256,000 image patches from a dataset of 400 images of retrospective clinical mammography exams, where dose reduction factors of 75% and 50% were simulated to generate low and standard-dose pairs. We validated the network in a real scenario by using a physical anthropomorphic breast phantom to acquire real low-dose and standard full-dose images in a commercially available mammography system, which were then processed through our trained model. We benchmarked our results against an analytical restoration model for low-dose digital mammography. Objective assessment was performed through the signal-to-noise ratio (SNR) and the mean normalized squared error (MNSE), decomposed into residual noise and bias. Statistical tests revealed that the use of the perceptual loss (PL4) resulted in statistically significant differences when compared to all other loss functions. Additionally, images restored using the PL4 achieved the closest residual noise to the standard dose. On the other hand, perceptual loss PL3, structural similarity index (SSIM) and one of the adversarial losses achieved the lowest bias for both dose reduction factors. The source code of our deep neural network is available at https://github.com/WANG-AXIS/LdDMDenoising.

Fast and low-dose medical imaging generation empowered by hybrid deep-learning and iterative reconstruction

Fast and low-dose reconstructions of medical images are highly desired in clinical routines. We propose a hybrid deep-learning and iterative reconstruction (hybrid DL-IR) framework and apply it for fast magnetic resonance imaging (MRI), fast positron emission tomography (PET), and low-dose computed tomography (CT) image generation tasks. First, in a retrospective MRI study (6,066 cases), we demonstrate its capability of handling 3- to 10-fold under-sampled MR data, enabling organ-level coverage with only 10- to 100-s scan time; second, a low-dose CT study (142 cases) shows that our framework can successfully alleviate the noise and streak artifacts in scans performed with only 10% radiation dose (0.61 mGy); and last, a fast whole-body PET study (131 cases) allows us to faithfully reconstruct tumor-induced lesions, including small ones (<4 mm), from 2- to 4-fold-accelerated PET acquisition (30-60 s/bp). This study offers a promising avenue for accurate and high-quality image reconstruction with broad clinical value.

Self-trained deep convolutional neural network for noise reduction in CT

Purpose

Supervised deep convolutional neural network (CNN)-based methods have been actively used in clinical CT to reduce image noise. The networks of these methods are typically trained using paired high- and low-quality data from a massive number of patients and/or phantom images. This training process is tedious, and the network trained under a given condition may not be generalizable to patient images acquired and reconstructed under different conditions. We propose a self-trained deep CNN (ST_CNN) method for noise reduction in CT that does not rely on pre-existing training datasets.

Approach

The ST_CNN training was accomplished using extensive data augmentation in the projection domain, and the inference was applied to the data itself. Specifically, multiple independent noise insertions were applied to the original patient projection data to generate multiple realizations of low-quality projection data. Then, rotation augmentation was adopted for both the original and low-quality projection data by applying the rotation angle directly on the projection data so that images were rotated at arbitrary angles without introducing additional bias. A large number of paired low- and high-quality images from the same patient were reconstructed and paired for training the ST_CNN model.

Results

No significant difference was found between the ST_CNN and conventional CNN models in terms of the peak signal-to-noise ratio and structural similarity index measure. The ST_CNN model outperformed the conventional CNN model in terms of noise texture and homogeneity in liver parenchyma as well as better subjective visualization of liver lesions. The ST_CNN may sacrifice the sharpness of vessels slightly compared to the conventional CNN model but without affecting the visibility of peripheral vessels or diagnosis of vascular pathology.

Conclusions

The proposed ST_CNN method trained from the data itself may achieve similar image quality in comparison with conventional deep CNN denoising methods pre-trained on external datasets.

Need for objective task-based evaluation of deep learning-based denoising methods: A study in the context of myocardial perfusion SPECT

BACKGROUND

Artificial intelligence-based methods have generated substantial interest in nuclear medicine. An area of significant interest has been the use of deep-learning (DL)-based approaches for denoising images acquired with lower doses, shorter acquisition times, or both. Objective evaluation of these approaches is essential for clinical application.

PURPOSE

DL-based approaches for denoising nuclear-medicine images have typically been evaluated using fidelity-based figures of merit (FoMs) such as root mean squared error (RMSE) and structural similarity index measure (SSIM). However, these images are acquired for clinical tasks and thus should be evaluated based on their performance in these tasks. Our objectives were to: (1) investigate whether evaluation with these FoMs is consistent with objective clinical-task-based evaluation; (2) provide a theoretical analysis for determining the impact of denoising on signal-detection tasks; and (3) demonstrate the utility of virtual imaging trials (VITs) to evaluate DL-based methods.

METHODS

A VIT to evaluate a DL-based method for denoising myocardial perfusion SPECT (MPS) images was conducted. To conduct this evaluation study, we followed the recently published best practices for the evaluation of AI algorithms for nuclear medicine (the RELAINCE guidelines). An anthropomorphic patient population modeling clinically relevant variability was simulated. Projection data for this patient population at normal and low-dose count levels (20%, 15%, 10%, 5%) were generated using well-validated Monte Carlo-based simulations. The images were reconstructed using a 3-D ordered-subsets expectation maximization-based approach. Next, the low-dose images were denoised using a commonly used convolutional neural network-based approach. The impact of DL-based denoising was evaluated using both fidelity-based FoMs and area under the receiver operating characteristic curve (AUC), which quantified performance on the clinical task of detecting perfusion defects in MPS images as obtained using a model observer with anthropomorphic channels. We then provide a mathematical treatment to probe the impact of post-processing operations on signal-detection tasks and use this treatment to analyze the findings of this study.

RESULTS

Based on fidelity-based FoMs, denoising using the considered DL-based method led to significantly superior performance. However, based on ROC analysis, denoising did not improve, and in fact, often degraded detection-task performance. This discordance between fidelity-based FoMs and task-based evaluation was observed at all the low-dose levels and for different cardiac-defect types. Our theoretical analysis revealed that the major reason for this degraded performance was that the denoising method reduced the difference in the means of the reconstructed images and of the channel operator-extracted feature vectors between the defect-absent and defect-present cases.

CONCLUSIONS

The results show the discrepancy between the evaluation of DL-based methods with fidelity-based metrics versus the evaluation on clinical tasks. This motivates the need for objective task-based evaluation of DL-based denoising approaches. Further, this study shows how VITs provide a mechanism to conduct such evaluations computationally, in a time and resource-efficient setting, and avoid risks such as radiation dose to the patient. Finally, our theoretical treatment reveals insights into the reasons for the limited performance of the denoising approach and may be used to probe the effect of other post-processing operations on signal-detection tasks.