Prior frequency guided diffusion model for limited angle (LA)-CBCT reconstruction.

Objective. Cone-beam computed tomography (CBCT) is widely used in image-guided radiotherapy. Reconstructing CBCTs from limited-angle acquisitions (LA-CBCT) is highly desired for improved imaging efficiency, dose reduction, and better mechanical clearance. LA-CBCT reconstruction, however, suffers from severe under-sampling artifacts, making it a highly ill-posed inverse problem. Diffusion models can generate data/images by reversing a data-noising process through learned data distributions; and can be incorporated as a denoiser/regularizer in LA-CBCT reconstruction. In this study, we developed a diffusion model-based framework, prior frequency-guided diffusion model (PFGDM), for robust and structure-preserving LA-CBCT reconstruction. Approach. PFGDM uses a conditioned diffusion model as a regularizer for LA-CBCT reconstruction, and the condition is based on high-frequency information extracted from patient-specific prior CT scans which provides a strong anatomical prior for LA-CBCT reconstruction. Specifically, we developed two variants of PFGDM (PFGDM-A and PFGDM-B) with different conditioning schemes. PFGDM-A applies the high-frequency CT information condition until a pre-optimized iteration step, and drops it afterwards to enable both similar and differing CT/CBCT anatomies to be reconstructed. PFGDM-B, on the other hand, continuously applies the prior CT information condition in every reconstruction step, while with a decaying mechanism, to gradually phase out the reconstruction guidance from the prior CT scans. The two variants of PFGDM were tested and compared with current available LA-CBCT reconstruction solutions, via metrics including peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM). Main results. PFGDM outperformed all traditional and diffusion model-based methods. The mean(s.d.) PSNR/SSIM were 27.97(3.10)/0.949(0.027), 26.63(2.79)/0.937(0.029), and 23.81(2.25)/0.896(0.036) for PFGDM-A, and 28.20(1.28)/0.954(0.011), 26.68(1.04)/0.941(0.014), and 23.72(1.19)/0.894(0.034) for PFGDM-B, based on 120°, 90°, and 30° orthogonal-view scan angles respectively. In contrast, the PSNR/SSIM was 19.61(2.47)/0.807(0.048) for 30° for DiffusionMBIR, a diffusion-based method without prior CT conditioning. Significance . PFGDM reconstructs high-quality LA-CBCTs under very-limited gantry angles, allowing faster and more flexible CBCT scans with dose reductions.