Deep Learning-Based Enhancement of Low-Dose Computed Tomography Images using Generative Adversarial Networks

Noise is inherent to low-dose CT acquisition. We propose to train a convolutional neural network (CNN) jointly with an adversarial CNN to estimate routine-dose CT images from low-dose CT images and hence reduce noise. A generator CNN was trained to transform low-dose CT images into routine-dose CT images using voxelwise loss minimization. An adversarial discriminator CNN was simultaneously trained to distinguish the output of the generator from routine-dose CT images. The performance of this discriminator was used as an adversarial loss for the generator. Experiments were performed using CT images of an anthropomorphic phantom containing calcium inserts, as well as patient non-contrast-enhanced cardiac CT images. The phantom and patients were scanned at 20% and 100% routine clinical dose. Three training strategies were compared: the first used only voxelwise loss, the second combined voxelwise loss and adversarial loss, and the third used only adversarial loss. The results showed that training with only voxelwise loss resulted in the highest peak signal-to-noise ratio with respect to reference routine-dose images. However, CNNs trained with adversarial loss captured image statistics of routine-dose images better. Noise reduction improved quantification of low-density calcified inserts in phantom CT images and allowed coronary calcium scoring in low-dose patient CT images with high noise levels. Testing took less than 10 s per CT volume. CNN-based low-dose CT noise reduction in the image domain is feasible. Training with an adversarial network improves the CNNs ability to generate images with an appearance similar to that of reference routine-dose CT images.

Computer-Aided-Diagnosis (CADx) systems assist radiologists with identifying and classifying potentially malignant pulmonary nodules on chest CT scans using morphology and texture-based (radiomic) features. However, radiomic features are sensitive to differences in acquisitions due to variations in dose levels and slice thickness. This study investigates the feasibility of generating a normalized scan from heterogeneous CT scans as input. We obtained projection data from 40 low-dose chest CT scans, simulating acquisitions at 10%, 25% and 50% dose and reconstructing the scans at 1.0mm and 2.0mm slice thickness. A 3D generative adversarial network (GAN) was used to simultaneously normalize reduced dose, thick slice (2.0mm) images to normal dose (100%), thinner slice (1.0mm) images. We evaluated the normalized image quality using peak signal-to-noise ratio (PSNR), structural similarity index (SSIM) and Learned Perceptual Image Patch Similarity (LPIPS). Our GAN improved perceptual similarity by 35%, compared to a baseline CNN method. Our analysis also shows that the GAN-based approach led to a significantly smaller error (p-value <; 0.05) in nine studied radiomic features. These results indicated that GANs could be used to normalize heterogeneous CT images and reduce the variability in radiomic feature values.

This study aimed to evaluate image quality, the detection rate of enlarged lymph nodes, and radiation dose exposure of ultralow-dose and low-dose abdominopelvic computed tomography (CT) in patients with lymphoma. Patients with lymphoma who underwent abdominopelvic CT using dual-source scanner were retrospectively recruited from a single center. CT images were obtained at 90 kVp dual-source mode reformatted in three data sets using the advanced modelled iterative reconstruction algorithm: 100% (standard-dose CT), 66.7% (low-dose CT), and 33.3% (ultralow-dose CT). Two radiologists analyzed subjective image quality and detection of abdominal enlarged lymph nodes on ultralow-dose, low-dose, and standard-dose CT blindly and independently. The results were compared with reference standards. Three readers (two radiologists and one hematologist) reviewed overall image quality and spleen size. In total, 128 consecutive CT scans (77 complete response, 44 partial response, 6 progressive disease, and 1 initial evaluation) from 86 patients (64 B-cell lymphoma, 14 T/NK-cell lymphoma, and 8 Hodgkin’s lymphoma cases) were assessed. The enlarged lymph node-based detection rates for two readers were 97.0% (96/99) and 94.0% (93/99) on standard-dose CT, 97.0% (96/99) and 94.0% (93/99) on low-dose CT, and 94.0% (93/99) and 89.9% (89/99) on ultralow-dose CT. Overall image quality was 3.8 ± 0.5, 3.9 ± 0.5, and 4.1 ± 0.5 on ultralow-dose CT; 4.7 ± 0.4, 4.6 ± 0.5, and 4.8 ± 0.3 on low-dose CT; and 4.8 ± 0.4, 4.7 ± 0.4, and 4.9 ± 0.2 on standard-dose CT, according to two radiologists and one hematologist, respectively. Intraclass correlation coefficients of spleen size were 0.90 (95% confidence interval [CI], 0.87–0.93), 0.91 (95% CI, 0.88–0.93), and 0.91 (95% CI, 0.88–0.93) on ultralow-dose, low-dose, and standard-dose CT, respectively. Mean effective radiation doses of standard-dose, low-dose, and ultralow-dose CT were 5.7 ±1.8 mSv, 3.8 ± 1.2 mSv, and 1.9 ± 0.6 mSv, respectively. Our findings suggest that ultralow-dose and low-dose CT, even with radiation doses reduced by 66.7% and 33.3%, respectively, maintained adequate image quality. These imaging modalities may be employed for follow-up lymphoma evaluation in consideration of the long surveillance periods.

Generative adversarial network (GAN) has been applied for low-dose CT images to predict normal-dose CT images. However, the undesired artifacts and details bring uncertainty to the clinical diagnosis. In order to improve the visual quality while suppressing the noise, in this paper, we mainly studied the two key components of deep learning based low-dose CT (LDCT) restoration models—network architecture and adversarial loss, and proposed a disentangled noise suppression method based on GAN (DNSGAN) for LDCT. Specifically, a generator network, which contains the noise suppression and structure recovery modules, is proposed. Furthermore, a multi-scaled relativistic adversarial loss is introduced to preserve the finer structures of generated images. Experiments on simulated and real LDCT datasets show that the proposed method can effectively remove noise while recovering finer details and provide better visual perception than other state-of-the-art methods.

Sparse-view low-dose computed tomography (LDCT) imaging poses difficulties in preserving image quality while reducing radiation exposure. Recent research has focused extensively on artificial intelligence (AI) to reduce artifacts in LDCT. This paper presents a unique integration based on a conditional generative adversarial network (CGAN) with metaheuristic optimization to improve the reconstruction of sparse-view computed tomography (CT) images. A Pix2Pix CGAN-based model was integrated with Particle Swarm Optimization (PSO), Differential Evolution (DE), and Cuckoo Search (CS) to improve essential hyperparameters, such as learning rate and beta values. The LDCT-P and LUNA16 datasets were used, producing seven levels of sparse-view CT images (10, 16, 32, 64, 128, 256, and 512 views) for assessment. The findings indicated a substantial improvement in image quality with an increase in the number of view projections. Pix2Pix+PSO demonstrated superior performance, with the Structural Similarity Index metric (SSIM) rising from 0.900 (10 views) to 0.972 (512 views) for abdominal CT and from 0.801 to 0.971 for lung CT, respectively. The results underscore the capability of the Pix2Pix model integrated with metaheuristic optimization to enhance sparse-view CT reconstruction. This method adeptly reconciles computing economy with image integrity, enabling improved LDCT imaging applications in clinical settings.

The effect of loss function on conditional generative adversarial networks

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. 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. 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. 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.

In recent years, health risks concerning high-dose x-ray radiation have become a major concern in dental computed tomography (CT) examinations. Therefore, adopting low-dose computed tomography (LDCT) technology has become a major focus in the CT imaging field. One of these LDCT technologies is downsampling data acquisition during low-dose x-ray imaging processes. However, reducing the radiation dose can adversely affect CT image quality by introducing noise and artifacts in the resultant image that can compromise diagnostic information. In this paper, we propose an artifact correction method for downsampling CT reconstruction based on deep learning. We used clinical dental CT data with low-dose artifacts reconstructed by conventional filtered back projection (FBP) as inputs to a deep neural network and corresponding high-quality labeled normal-dose CT data during training. We trained a generative adversarial network (GAN) with Wasserstein distance (WGAN) and mean squared error (MSE) loss, called m-WGAN, to remove artifacts and obtain high-quality CT dental images in a clinical dental CT examination environment. The experimental results confirmed that the proposed algorithm effectively removes low-dose artifacts from dental CT scans. In addition, we showed that the proposed method is efficient for removing noise from low-dose CT scan images compared to existing approaches. We compared the performances of the general GAN, convolutional neural networks, and m-WGAN. Through quantitative and qualitative analysis of the results, we concluded that the proposed m-WGAN method resulted in better artifact correction performance preserving the texture in dental CT scanning. The image quality evaluation metrics indicated that the proposed method effectively improves image quality when used as a postprocessing technique for dental CT images. To the best of our knowledge, this work is the first deep learning architecture used with a commercial cone-beam dental CT scanner. The artifact correction performance was rigorously evaluated and demonstrated to be effective. Therefore, we believe that the proposed algorithm represents a new direction in the research area of low-dose dental CT artifact correction.

CT image quality enhancement via a dual-channel neural network with jointing denoising and super-resolution

The superior soft-tissue contrast achieved using magnetic resonance imaging (MRI) compared to x-ray computed tomography (CT) has led to the popularization of MRI-guided radiation therapy (MR-IGRT), especially in recent years with the advent of first and second generation MRI-based therapy delivery systems for MR-IGRT. The expanding use of these systems is driving interest in MRI-only RT workflows in which MRI is the sole imaging modality used for treatment planning and dose calculations. To enable such a workflow, synthetic CT (sCT) data must be generated based on a patient's MRI data so that dose calculations may be performed using the electron density information derived from CT images. In this study, we propose a novel deep spatial pyramid convolutional framework for the MRI-to-CT image-to-image translation task and compare its performance to the well established U-Net architecture in a generative adversarial network (GAN) framework. Our proposed framework utilizes atrous convolution in a method named atrous spatial pyramid pooling (ASPP) to significantly reduce the total number of parameters required to describe the model while effectively capturing rich, multi-scale structural information in a manner that is not possible in the conventional framework. The proposed framework consists of a generative model composed of stacked encoders and decoders separated by the ASPP module, where atrous convolution is applied at increasing rates in parallel to encode large-scale features. The performance of the proposed method is compared to that of the conventional GAN framework in terms of the time required to train the model and the image quality of the generated sCT as measured by the root mean square error (RMSE), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR) depending on the size of the training data set. Dose calculations based on sCT data generated using the proposed architecture are also compared to clinical plans to evaluate the dosimetric accuracy of the method. Significant reductions in training time and improvements in image quality are observed at every training data set size when the proposed framework is adopted instead of the conventional framework. Over 1042 test images, values of 17.7±4.3HU, 0.9995±0.0003, and 71.7±2.3 are observed for the RMSE, SSIM, and PSNR metrics, respectively. Dose distributions calculated based on sCT data generated using the proposed framework demonstrate passing rates equal to or greater than 98% using the 3D gamma index with a 2%/2mm criterion. The deep spatial pyramid convolutional framework proposed here demonstrates improved performance compared to the conventional GAN framework that has been applied to the image-to-image translation task of sCT generation. Adopting the method is a first step toward an MRI-only RT workflow that enables widespread clinical applications for MR-IGRT including online adaptive therapy.

In the automatic sorting process of express delivery, a three-segment code is used to represent a specific area assigned by a specific delivery person. In the process of obtaining the courier order information, the camera is affected by factors such as light, noise, and subject shake, which will cause the information on the courier order to be blurred, and some information will be lost. Therefore, this paper proposes an image text deblurring method based on a generative adversarial network. The model of the algorithm consists of two generative adversarial networks, combined with Wasserstein distance, using a combination of adversarial loss and perceptual loss on unpaired datasets to train the network model to restore the captured blurred images into clear and natural image. Compared with the traditional method, the advantage of this method is that the loss function between the input and output images can be calculated indirectly through the positive and negative generative adversarial networks. The Wasserstein distance can achieve a more stable training process and a more realistic generation effect. The constraints of adversarial loss and perceptual loss make the model capable of training on unpaired datasets. The experimental results on the GOPRO test dataset and the self-built unpaired dataset showed that the two indicators, peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM), increased by 13.3% and 3%, respectively. The human perception test results demonstrated that the algorithm proposed in this paper was better than the traditional blur algorithm as the deblurring effect was better.

Deep learning image reconstruction (DLIR) is a new reconstruction method for maintaining image quality at reduced radiation dose. The purpose of this study was to compare image quality of reduced-dose DLIR images with the standard-dose adaptive statistical iterative reconstruction (ASIR-V) images in chest CT. Our prospective study included 48 adult patients (30 women and 18 men, mean age ±SD, 49.8 ± 14.3 years) who underwent both the standard-dose CT (SDCT) and low-dose CT (LDCT) on a GE Revolution CT scanner. All patients gave written informed consent. All scans were reconstructed with ASIR-V40%. Additionally, LDCT scans were reconstructed with DLIR with high-setting (DLIR-H) and medium-setting (DLIR-M). Image noise and contrast-noise-ratio (CNR) of thoracic aorta with different reconstruction modes were measured and compared. LDCT reduced radiation dose by 96% compared with SDCT (CTDIvol: 0.54mGy vs 12.46mGy). In LDCT, DLIR significantly reduced image noise compared with the state-of-the-art ASIR-V40% with DLIR-H provided the lowest image noise and highest image quality score. In addition, the image noise, CNR of aorta and overall image quality of the low-dose DLIR-H images did not have significant difference compared with the SDCT ASIR-V40% images (all p > 0.05). DLIR significantly reduces image noise in LDCT chest scans and provides similar image quality as the SDCT ASIR-V images at 4% of the radiation dose. DLIR uses high-quality FBP data to train deep neural networks to learn how to distinguish between signal and noise, and effectively suppresses noise without affecting anatomical and pathological structures. It opens a new era of CT image reconstruction. DLIR significantly reduces image noise and improves image quality compared with ASIR-V40% under same radiation dose condition. DLIR-H achieves similar image quality at 4% radiation dose as ASIR-V40% at standard-dose level in non-contrast chest CT.

Computed tomography (CT) is a valuable imaging modality for pulmonary imaging. Fast acquisition times and sharp cross-sectional images guarantee high diagnostic confidence. With the introduction of low-dose CT, it has been established as standard for lung screening of heavy smokers in many countries around the world. However, at some point the limits for dose reduction with conventional CT are reached and further reduction would suffer from poor image quality. Sparsesampling CT is one technology that would allow a further radiation dose reduction by reducing the number of acquired projection images. Recently, the feasibility of a fast pulsing X-ray tube for CT has been demonstrated, indicating that sparse sampling could become available in future generations of CT scanners. Therefore, we investigated the effect of sparse sampling by a stepwise reduction of the projection images. A lung phantom with synthetic pulmonary nodules was scanned with a clinical CT system. Sparse sampling was simulated by removing projection images prior to reconstruction. The phantom was scanned at the iso-center and at the highest possible table position (off-center). The modulation transfer function (MTF) was determined for different degrees of sparse sampling. Image quality was evaluated by comparing the reduced dose simulations against the full dose image using the structural similarity index (SSIM). MTF was stable down to using 1/4th of the projection images (4-times sparse sampling, SpS-4) with high degradation at the off-center position (full sampling (FS) 10% MTF, iso-center: 0.64; off-center: 0.47). SSIM indicates a small image quality degradation of FS images compared to sparse-sampling images at low radiation doses at the iso-center (35 mAs; FS: 0.91; SpS-4: 0.93) and stronger degradations at the off-center position (35 mAs; FS: 0.65; SpS-4: 0.84). In conclusion, sparse sampling provides stable MTF results down to 1/4th of the projection images. At low dose levels (iso-center: ≤43 mAs; off-center: ≤86 mAs), sparse sampling performs better in terms of SSIM compared to FS.

BackgroundAnterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. We developed a novel, low dose computed tomography (LDCT) protocol to assess tunnel position post-operatively. The effective radiation dose of this protocol is < 0.5millisieverts (mSv), which is significantly less than the 2 mSv dose for a conventional CT protocol. The aim of this study was to assess the accuracy of the LDCT protocol for determining tunnel position.MethodsTwenty-six patients who underwent primary ACL reconstruction were included in the study. A LDCT scan was performed 6 weeks post-operatively. Femoral and tibial tunnel positions were measured on three dimensional (3D) reconstructions using previously validated techniques. Measurements were performed independently by three observers at two time points, 4 weeks apart.ResultsThere was excellent intra- and inter-rater reliability for all measurements using the images obtained from the LDCT protocol. Intra-class correlation coefficient (ICC) values were > 0.9 for all measurements.ConclusionsThe LDCT protocol described in this study accurately demonstrates femoral and tibial tunnels post ACL reconstruction, while exposing the patient to a quarter of the radiation dose of a conventional CT. This protocol could be used by orthopaedic surgeons for routine post-operative imaging, in place of plain film radiographs.

2204 LOW DOSE CT SCAN YIELDS EQUIVALENT STONE MEASUREMENTS WHEN COMPARED TO STANDARD CT SCAN WITH LARGE REDUCTIONS IN RADIATION EXPOSURE