Metal artifacts in computed tomography (CT) images can significantly degrade image quality and impede accurate diagnosis. Supervised metal artifact reduction (MAR) methods, trained using simulated datasets, often struggle to perform well on real clinical CT images due to a substantial domain gap. Although state-of-the-art semi-supervised methods use pseudo ground-truths generated by a prior network to mitigate this issue, their reliance on a fixed prior limits both the quality and quantity of these pseudo ground-truths, introducing confirmation bias and reducing clinical applicability. To address these limitations, we propose a novel Radiologist-In-the-loop SElf-training framework for MAR, termed RISE-MAR, which can integrate radiologists' feedback into the semi-supervised learning process, progressively improving the quality and quantity of pseudo ground-truths for enhanced generalization on real clinical CT images. For quality assurance, we introduce a clinical quality assessor model that emulates radiologist evaluations, effectively selecting high-quality pseudo ground-truths for semi-supervised training. For quantity assurance, our self-training framework iteratively generates additional high-quality pseudo ground-truths, expanding the clinical dataset and further improving model generalization. Extensive experimental results on multiple clinical datasets demonstrate the superior generalization performance of our RISE-MAR over state-of-the-art methods, advancing the development of MAR models for practical application. Code is available at https://github.com/Masaaki-75/rise-mar.
For the planning of radiotherapy treatments for head and neck cancers, Computed Tomography (CT) scans of the patients are typically employed. However, in patients with head and neck cancer, the quality of standard CT scans generated using kilo-Voltage (kVCT) tube potentials is severely degraded by streak artifacts occurring in the presence of metallic implants such as dental fillings. Some radiotherapy devices offer the possibility of acquiring Mega-Voltage CT (MVCT) for daily patient setup verification, due to the higher energy of X-rays used, MVCT scans are almost entirely free from artifacts making them more suitable for radiotherapy treatment planning. In this study, we leverage the advantages of kVCT scans with those of MVCT scans (artifact-free). We propose a deep learning-based approach capable of generating artifact-free MVCT images from acquired kVCT images. The outcome offers the benefits of artifact-free MVCT images with enhanced soft tissue contrast, harnessing valuable information obtained through kVCT technology for precise therapy calibration. Our proposed method employs UNet-inspired model, and is compared with adversarial learning and transformer networks. This first and unique approach achieves remarkable success, with PSNR of 30.02 dB across the entire patient volume and 27.47 dB in artifact-affected regions exclusively. It is worth noting that the PSNR calculation excludes the background, concentrating solely on the region of interest.
Metal artifacts in computed tomography (CT) imaging pose significant challenges to accurate clinical diagnosis. The presence of high-density metallic implants results in artifacts that deteriorate image quality, manifesting in the forms of streaking, blurring, or beam hardening effects, etc. Nowadays, various deep learning-based approaches, particularly generative models, have been proposed for metal artifact reduction (MAR). However, these methods have limited perception ability in the diverse morphologies of different metal implants with artifacts, which may generate spurious anatomical structures and exhibit inferior generalization capability. To address the issues, we leverage visual-language model (VLM) to identify these morphological features and introduce them into a dual-domain CLIP-assisted residual optimization perception model (DuDoCROP) for MAR. Specifically, a dual-domain CLIP (DuDoCLIP) is fine-tuned on the image domain and sinogram domain using contrastive learning to extract semantic descriptions from anatomical structures and metal artifacts. Subsequently, a diffusion model is guided by the embeddings of DuDoCLIP, thereby enabling the dual-domain prior generation. Additionally, we design prompt engineering for more precise image-text descriptions that can enhance the model's perception capability. Then, a downstream task is devised for the one-step residual optimization and integration of dual-domain priors, while incorporating raw data fidelity. Ultimately, a new perceptual indicator is proposed to validate the model's perception and generation performance. With the assistance of DuDoCLIP, our DuDoCROP exhibits at least 63.7% higher generalization capability compared to the baseline model. Numerical experiments demonstrate that the proposed method can generate more realistic image structures and outperform other SOTA approaches both qualitatively and quantitatively.
X-ray computed tomography (CT) reconstructs the internal morphology of a three dimensional object from a collection of projection images, most commonly using a single rotation axis. However, for objects containing dense materials like metal, the use of a single rotation axis may leave some regions of the object obscured by the metal, even though projections from other rotation axes (or poses) might contain complementary information that would better resolve these obscured regions. In this paper, we propose pixel-weighted Multi-pose Fusion to reduce metal artifacts by fusing the information from complementary measurement poses into a single reconstruction. Our method uses Multi-Agent Consensus Equilibrium (MACE), an extension of Plug-and-Play, as a framework for integrating projection data from different poses. A primary novelty of the proposed method is that the output of different MACE agents are fused in a pixel-weighted manner to minimize the effects of metal throughout the reconstruction. Using real CT data on an object with and without metal inserts, we demonstrate that the proposed pixel-weighted Multi-pose Fusion method significantly reduces metal artifacts relative to single-pose reconstructions.
In computed tomography (CT), the presence of metallic implants in patients often leads to disruptive artifacts in the reconstructed images, hindering accurate diagnosis. Recently, a large amount of supervised deep learning-based approaches have been proposed for metal artifact reduction (MAR). However, these methods neglect the influence of initial training weights. In this paper, we have discovered that the uncertainty image computed from the restoration result of initial training weights can effectively highlight high-frequency regions, including metal artifacts. This observation can be leveraged to assist the MAR network in removing metal artifacts. Therefore, we propose an uncertainty constraint (UC) loss that utilizes the uncertainty image as an adaptive weight to guide the MAR network to focus on the metal artifact region, leading to improved restoration. The proposed UC loss is designed to be a plug-and-play method, compatible with any MAR framework, and easily adoptable. To validate the effectiveness of the UC loss, we conduct extensive experiments on the public available Deeplesion and CLINIC-metal dataset. Experimental results demonstrate that the UC loss further optimizes the network training process and significantly improves the removal of metal artifacts.
X-ray CT often suffers from shadowing and streaking artifacts in the presence of metallic materials, which severely degrade imaging quality. Physically, the linear attenuation coefficients (LACs) of metals vary significantly with X-ray energy, causing a nonlinear beam hardening effect (BHE) in CT measurements. Reconstructing CT images from metal-corrupted measurements consequently becomes a challenging nonlinear inverse problem. Existing state-of-the-art (SOTA) metal artifact reduction (MAR) algorithms rely on supervised learning with numerous paired CT samples. While promising, these supervised methods often assume that the unknown LACs are energy-independent, ignoring the energy-induced BHE, which results in limited generalization. Moreover, the requirement for large datasets also limits their applications in real-world scenarios. In this work, we propose Density neural representation (Diner), a novel unsupervised MAR method. Our key innovation lies in formulating MAR as an energy-independent density reconstruction problem that strictly adheres to the photon-tissue absorption physical model. This model is inherently nonlinear and complex, making it a rarely considered approach in inverse imaging problems. By introducing the water-equivalent tissues approximation and a new polychromatic model to characterize the nonlinear CT acquisition process, we directly learn the neural representation of the density map from raw measurements without using external training data. This energy-independent density reconstruction framework fundamentally resolves the nonlinear BHE, enabling superior MAR performance across a wide range of scanning scenarios. Extensive experiments on both simulated and real-world datasets demonstrate the superiority of our unsupervised Diner over popular supervised methods in terms of MAR performance and robustness.
Emerging neural reconstruction techniques based on tomography (e.g., NeRF, NeAT, and NeRP) have started showing unique capabilities in medical imaging. In this work, we present a novel Polychromatic neural representation (Polyner) to tackle the challenging problem of CT imaging when metallic implants exist within the human body. CT metal artifacts arise from the drastic variation of metal's attenuation coefficients at various energy levels of the X-ray spectrum, leading to a nonlinear metal effect in CT measurements. Recovering CT images from metal-affected measurements hence poses a complicated nonlinear inverse problem where empirical models adopted in previous metal artifact reduction (MAR) approaches lead to signal loss and strongly aliased reconstructions. Polyner instead models the MAR problem from a nonlinear inverse problem perspective. Specifically, we first derive a polychromatic forward model to accurately simulate the nonlinear CT acquisition process. Then, we incorporate our forward model into the implicit neural representation to accomplish reconstruction. Lastly, we adopt a regularizer to preserve the physical properties of the CT images across different energy levels while effectively constraining the solution space. Our Polyner is an unsupervised method and does not require any external training data. Experimenting with multiple datasets shows that our Polyner achieves comparable or better performance than supervised methods on in-domain datasets while demonstrating significant performance improvements on out-of-domain datasets. To the best of our knowledge, our Polyner is the first unsupervised MAR method that outperforms its supervised counterparts. The code for this work is available at: https://github.com/iwuqing/Polyner.
Cone Beam Computed Tomography (CBCT) plays a key role in dental diagnosis and surgery. However, the metal teeth implants could bring annoying metal artifacts during the CBCT imaging process, interfering diagnosis and downstream processing such as tooth segmentation. In this paper, we develop an efficient Transformer to perform metal artifacts reduction (MAR) from dental CBCT images. The proposed MAR Transformer (MARformer) reduces computation complexity in the multihead self-attention by a new Dimension-Reduced Self-Attention (DRSA) module, based on that the CBCT images have globally similar structure. A Patch-wise Perceptive Feed Forward Network (P2FFN) is also proposed to perceive local image information for fine-grained restoration. Experimental results on CBCT images with synthetic and real-world metal artifacts show that our MARformer is efficient and outperforms previous MAR methods and two restoration Transformers.
During the process of computed tomography (CT), metallic implants often cause disruptive artifacts in the reconstructed images, impeding accurate diagnosis. Several supervised deep learning-based approaches have been proposed for reducing metal artifacts (MAR). However, these methods heavily rely on training with simulated data, as obtaining paired metal artifact CT and clean CT data in clinical settings is challenging. This limitation can lead to decreased performance when applying these methods in clinical practice. Existing unsupervised MAR methods, whether based on learning or not, typically operate within a single domain, either in the image domain or the sinogram domain. In this paper, we propose an unsupervised MAR method based on the diffusion model, a generative model with a high capacity to represent data distributions. Specifically, we first train a diffusion model using CT images without metal artifacts. Subsequently, we iteratively utilize the priors embedded within the pre-trained diffusion model in both the sinogram and image domains to restore the degraded portions caused by metal artifacts. This dual-domain processing empowers our approach to outperform existing unsupervised MAR methods, including another MAR method based on the diffusion model, which we have qualitatively and quantitatively validated using synthetic datasets. Moreover, our method demonstrates superior visual results compared to both supervised and unsupervised methods on clinical datasets.
This study introduces a novel reconstruction method for dental cone-beam computed tomography (CBCT), focusing on effectively reducing metal-induced artifacts commonly encountered in the presence of prevalent metallic implants. Despite significant progress in metal artifact reduction techniques, challenges persist owing to the intricate physical interactions between polychromatic X-ray beams and metal objects, which are further compounded by the additional effects associated with metal-tooth interactions and factors specific to the dental CBCT data environment. To overcome these limitations, we propose an implicit neural network that generates two distinct and informative tomographic images. One image represents the monochromatic attenuation distribution at a specific energy level, whereas the other captures the nonlinear beam-hardening factor resulting from the polychromatic nature of X-ray beams. In contrast to existing CT reconstruction techniques, the proposed method relies exclusively on the Beer--Lambert law, effectively preventing the generation of metal-induced artifacts during the backprojection process commonly implemented in conventional methods. Extensive experimental evaluations demonstrate that the proposed method effectively reduces metal artifacts while providing high-quality image reconstructions, thus emphasizing the significance of the second image in capturing the nonlinear beam-hardening factor.
CT images corrupted by metal artifacts have serious negative effects on clinical diagnosis. Considering the difficulty of collecting paired data with ground truth in clinical settings, unsupervised methods for metal artifact reduction are of high interest. However, it is difficult for previous unsupervised methods to retain structural information from CT images while handling the non-local characteristics of metal artifacts. To address these challenges, we proposed a novel Dense Transformer based Enhanced Coding Network (DTEC-Net) for unsupervised metal artifact reduction. Specifically, we introduce a Hierarchical Disentangling Encoder, supported by the high-order dense process, and transformer to obtain densely encoded sequences with long-range correspondence. Then, we present a second-order disentanglement method to improve the dense sequence's decoding process. Extensive experiments and model discussions illustrate DTEC-Net's effectiveness, which outperforms the previous state-of-the-art methods on a benchmark dataset, and greatly reduces metal artifacts while restoring richer texture details.
Sparse-view computed tomography (CT) has been adopted as an important technique for speeding up data acquisition and decreasing radiation dose. However, due to the lack of sufficient projection data, the reconstructed CT images often present severe artifacts, which will be further amplified when patients carry metallic implants. For this joint sparse-view reconstruction and metal artifact reduction task, most of the existing methods are generally confronted with two main limitations: 1) They are almost built based on common network modules without fully embedding the physical imaging geometry constraint of this specific task into the dual-domain learning; 2) Some important prior knowledge is not deeply explored and sufficiently utilized. Against these issues, we specifically construct a dual-domain reconstruction model and propose a model-driven equivariant proximal network, called MEPNet. The main characteristics of MEPNet are: 1) It is optimization-inspired and has a clear working mechanism; 2) The involved proximal operator is modeled via a rotation equivariant convolutional neural network, which finely represents the inherent rotational prior underlying the CT scanning that the same organ can be imaged at different angles. Extensive experiments conducted on several datasets comprehensively substantiate that compared with the conventional convolution-based proximal network, such a rotation equivariance mechanism enables our proposed method to achieve better reconstruction performance with fewer network parameters. We will release the code at \url{https://github.com/hongwang01/MEPNet}.
Metal artifacts is a major challenge in computed tomography (CT) imaging, significantly degrading image quality and making accurate diagnosis difficult. However, previous methods either require prior knowledge of the location of metal implants, or have modeling deviations with the mechanism of artifact formation, which limits the ability to obtain high-quality CT images. In this work, we formulate metal artifacts reduction problem as a combination of decomposition and completion tasks. And we propose RetinexFlow, which is a novel end-to-end image domain model based on Retinex theory and conditional normalizing flow, to solve it. Specifically, we first design a feature decomposition encoder for decomposing the metal implant component and inherent component, and extracting the inherent feature. Then, it uses a feature-to-image flow module to complete the metal artifact-free CT image step by step through a series of invertible transformations. These designs are incorporated in our model with a coarse-to-fine strategy, enabling it to achieve superior performance. The experimental results on on simulation and clinical datasets show our method achieves better quantitative and qualitative results, exhibiting better visual performance in artifact removal and image fidelity
During X-ray computed tomography (CT) scanning, metallic implants carrying with patients often lead to adverse artifacts in the captured CT images and then impair the clinical treatment. Against this metal artifact reduction (MAR) task, the existing deep-learning-based methods have gained promising reconstruction performance. Nevertheless, there is still some room for further improvement of MAR performance and generalization ability, since some important prior knowledge underlying this specific task has not been fully exploited. Hereby, in this paper, we carefully analyze the characteristics of metal artifacts and propose an orientation-shared convolution representation strategy to adapt the physical prior structures of artifacts, i.e., rotationally symmetrical streaking patterns. The proposed method rationally adopts Fourier-series-expansion-based filter parametrization in artifact modeling, which can better separate artifacts from anatomical tissues and boost the model generalizability. Comprehensive experiments executed on synthesized and clinical datasets show the superiority of our method in detail preservation beyond the current representative MAR methods. Code will be available at \url{https://github.com/hongwang01/OSCNet}
The existence of metallic implants in projection images for cone-beam computed tomography (CBCT) introduces undesired artifacts which degrade the quality of reconstructed images. In order to reduce metal artifacts, projection inpainting is an essential step in many metal artifact reduction algorithms. In this work, a hybrid network combining the shift window (Swin) vision transformer (ViT) and a convolutional neural network is proposed as a baseline network for the inpainting task. To incorporate metal information for the Swin ViT-based encoder, metal-conscious self-embedding and neighborhood-embedding methods are investigated. Both methods have improved the performance of the baseline network. Furthermore, by choosing appropriate window size, the model with neighborhood-embedding could achieve the lowest mean absolute error of 0.079 in metal regions and the highest peak signal-to-noise ratio of 42.346 in CBCT projections. At the end, the efficiency of metal-conscious embedding on both simulated and real cadaver CBCT data has been demonstrated, where the inpainting capability of the baseline network has been enhanced.
Recent deep learning-based methods have achieved promising performance for computed tomography metal artifact reduction (CTMAR). However, most of them suffer from two limitations: (i) the domain knowledge is not fully embedded into the network training; (ii) metal artifacts lack effective representation models. The aforementioned limitations leave room for further performance improvement. Against these issues, we propose a novel triple domain model-driven CTMAR network, termed as TriDoNet, whose network training exploits triple domain knowledge, i.e., the knowledge of the sinogram, CT image, and metal artifact domains. Specifically, to explore the non-local repetitive streaking patterns of metal artifacts, we encode them as an explicit tight frame sparse representation model with adaptive thresholds. Furthermore, we design a contrastive regularization (CR) built upon contrastive learning to exploit clean CT images and metal-affected images as positive and negative samples, respectively. Experimental results show that our TriDoNet can generate superior artifact-reduced CT images.
During orthopaedic surgery, the inserting of metallic implants or screws are often performed under mobile C-arm systems. Due to the high attenuation of metals, severe metal artifacts occur in 3D reconstructions, which degrade the image quality greatly. To reduce the artifacts, many metal artifact reduction algorithms have been developed and metal inpainting in projection domain is an essential step. In this work, a score-based generative model is trained on simulated knee projections and the inpainted image is obtained by removing the noise in conditional resampling process. The result implies that the inpainted images by score-based generative model have more detailed information and achieve the lowest mean absolute error and the highest peak-signal-to-noise-ratio compared with interpolation and CNN based method. Besides, the score-based model can also recover projections with big circlar and rectangular masks, showing its generalization in inpainting task.
Metal artifact correction is a challenging problem in cone beam computed tomography (CBCT) scanning. Metal implants inserted into the anatomy cause severe artifacts in reconstructed images. Widely used inpainting-based metal artifact reduction (MAR) methods require segmentation of metal traces in the projections as a first step, which is a challenging task. One approach is to use a deep learning method to segment metals in the projections. However, the success of deep learning methods is limited by the availability of realistic training data. It is laborious and time consuming to get reliable ground truth annotations due to unclear implant boundaries and large numbers of projections. We propose to use X-ray simulations to generate synthetic metal segmentation training dataset from clinical CBCT scans. We compare the effect of simulations with different numbers of photons and also compare several training strategies to augment the available data. We compare our model's performance on real clinical scans with conventional region growing threshold-based MAR, moving metal artifact reduction method, and a recent deep learning method. We show that simulations with relatively small number of photons are suitable for the metal segmentation task and that training the deep learning model with full size and cropped projections together improves the robustness of the model. We show substantial improvement in the image quality affected by severe motion, voxel size under-sampling, and out-of-FOV metals. Our method can be easily integrated into the existing projection-based MAR pipeline to get improved image quality. This method can provide a novel paradigm to accurately segment metals in CBCT projections.
Metal implants and other high-density objects in patients introduce severe streaking artifacts in CT images, compromising image quality and diagnostic performance. Although various methods were developed for CT metal artifact reduction over the past decades, including the latest dual-domain deep networks, remaining metal artifacts are still clinically challenging in many cases. Here we extend the state-of-the-art dual-domain deep network approach into a quad-domain counterpart so that all the features in the sinogram, image, and their corresponding Fourier domains are synergized to eliminate metal artifacts optimally without compromising structural subtleties. Our proposed quad-domain network for MAR, referred to as Quad-Net, takes little additional computational cost since the Fourier transform is highly efficient, and works across the four receptive fields to learn both global and local features as well as their relations. Specifically, we first design a Sinogram-Fourier Restoration Network (SFR-Net) in the sinogram domain and its Fourier space to faithfully inpaint metal-corrupted traces. Then, we couple SFR-Net with an Image-Fourier Refinement Network (IFR-Net) which takes both an image and its Fourier spectrum to improve a CT image reconstructed from the SFR-Net output using cross-domain contextual information. Quad-Net is trained on clinical datasets to minimize a composite loss function. Quad-Net does not require precise metal masks, which is of great importance in clinical practice. Our experimental results demonstrate the superiority of Quad-Net over the state-of-the-art MAR methods quantitatively, visually, and statistically. The Quad-Net code is publicly available at https://github.com/longzilicart/Quad-Net.
Inspired by the great success of deep neural networks, learning-based methods have gained promising performances for metal artifact reduction (MAR) in computed tomography (CT) images. However, most of the existing approaches put less emphasis on modelling and embedding the intrinsic prior knowledge underlying this specific MAR task into their network designs. Against this issue, we propose an adaptive convolutional dictionary network (ACDNet), which leverages both model-based and learning-based methods. Specifically, we explore the prior structures of metal artifacts, e.g., non-local repetitive streaking patterns, and encode them as an explicit weighted convolutional dictionary model. Then, a simple-yet-effective algorithm is carefully designed to solve the model. By unfolding every iterative substep of the proposed algorithm into a network module, we explicitly embed the prior structure into a deep network, \emph{i.e.,} a clear interpretability for the MAR task. Furthermore, our ACDNet can automatically learn the prior for artifact-free CT images via training data and adaptively adjust the representation kernels for each input CT image based on its content. Hence, our method inherits the clear interpretability of model-based methods and maintains the powerful representation ability of learning-based methods. Comprehensive experiments executed on synthetic and clinical datasets show the superiority of our ACDNet in terms of effectiveness and model generalization. {\color{blue}{{\textit{Code is available at {\url{https://github.com/hongwang01/ACDNet}}.}}}}