Splat-Based Metal Artifact Reduction in Cone-Beam CT via Compact Attenuation Modeling

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

Revisiting Pose Sensitivity in Splat-based Computed Tomography under Sparse-view Reconstruction

X-ray computed tomography (CT) reconstructs volumetric representations of objects from projection images obtained by transmitting X-rays through a target. Recent splat-based tomography, which represents a volume as a continuous distribution of 3D Gaussians, has demonstrated both high reconstruction quality and fast convergence in cone-beam sparse-view CT. However, when deployed in real CT systems with limited and non-uniform view distributions, we observe distinctive streak and strip artifacts that are far more pronounced than in conventional reconstruction methods. Through detailed analysis, we show that these artifacts primarily originate from pose inaccuracies in the acquisition geometry rather than from view sparsity itself. We revisit pose sensitivity in the splatting formulation and derive a stable gradient-based framework that jointly refines geometric parameters during reconstruction. Our study not only identifies how pose perturbations propagate through the differentiable projection operator but also reveals why splat-based CT is particularly vulnerable to geometric misalignment. The resulting formulation remains lightweight and easily integrable into existing pipelines while substantially improving reconstruction fidelity under real-world sparse-view conditions.

CBCT-IQ: A Publicly Available Annotated Cone-Beam CT Dataset for Image Quality Assessment and Benchmarking

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

Robustness and Stability Analysis of Differentiable Shift-Variant FBP for Cone-Beam CT under Challenging Acquisition Settings

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

From Data Completeness to Data Sufficiency: A Task-Driven Imaging Framework for Intraoperative CBCT under Quality-Time-Dose Trade-offs

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