We present a principled framework for confidence estimation in computed tomography (CT) reconstruction. Based on the sequential likelihood mixing framework (Kirschner et al., 2025), we establish confidence regions with theoretical coverage guarantees for deep-learning-based CT reconstructions. We consider a realistic forward model following the Beer-Lambert law, i.e., a log-linear forward model with Poisson noise, closely reflecting clinical and scientific imaging conditions. The framework is general and applies to both classical algorithms and deep learning reconstruction methods, including U-Nets, U-Net ensembles, and generative Diffusion models. Empirically, we demonstrate that deep reconstruction methods yield substantially tighter confidence regions than classical reconstructions, without sacrificing theoretical coverage guarantees. Our approach allows the detection of hallucinations in reconstructed images and provides interpretable visualizations of confidence regions. This establishes deep models not only as powerful estimators, but also as reliable tools for uncertainty-aware medical imaging.

Deep learning has brought significant advancements to X-ray Computed Tomography (CT) reconstruction, offering solutions to challenges arising from modern imaging technologies. These developments benefit from methods that combine classical reconstruction techniques with data-driven approaches. Differentiable operators play a key role in this integration by enabling end-to-end optimization and the incorporation of physical modeling within neural networks. In this work, we present an updated version of PYRO-NN, a Python-based library for differentiable CT reconstruction. The updated framework extends compatibility to PyTorch and introduces native CUDA kernel support for efficient projection and back-projection operations across parallel, fan, and cone-beam geometries. Additionally, it includes tools for simulating imaging artifacts, modeling arbitrary acquisition trajectories, and creating flexible, end-to-end trainable pipelines through a high-level Python API. Code is available at: https://github.com/csyben/PYRO-NN

Cone-beam computed tomography (CBCT) is widely used for image-guided radiotherapy (IGRT). It provides real time visualization at low cost and dose. However, photon scattering and beam hindrance cause artifacts in CBCT. These include inaccurate Hounsfield Units (HU), reducing reliability for dose calculation, and adaptive planning. By contrast, computed tomography (CT) offers better image quality and accurate HU calibration but is usually acquired offline and fails to capture intra-treatment anatomical changes. Thus, accurate CBCT-to-CT synthesis is needed to close the imaging-quality gap in adaptive radiotherapy workflows. To cater to this, we propose a novel diffusion-based conditional generative model, coined EqDiff-CT, to synthesize high-quality CT images from CBCT. EqDiff-CT employs a denoising diffusion probabilistic model (DDPM) to iteratively inject noise and learn latent representations that enable reconstruction of anatomically consistent CT images. A group-equivariant conditional U-Net backbone, implemented with e2cnn steerable layers, enforces rotational equivariance (cyclic C4 symmetry), helping preserve fine structural details while minimizing noise and artifacts. The system was trained and validated on the SynthRAD2025 dataset, comprising CBCT-CT scans across multiple head-and-neck anatomical sites, and we compared it with advanced methods such as CycleGAN and DDPM. EqDiff-CT provided substantial gains in structural fidelity, HU accuracy and quantitative metrics. Visual findings further confirm the improved recovery, sharper soft tissue boundaries, and realistic bone reconstructions. The findings suggest that the diffusion model has offered a robust and generalizable framework for CBCT improvements. The proposed solution helps in improving the image quality as well as the clinical confidence in the CBCT-guided treatment planning and dose calculations.

Photoacoustic computed tomography (PACT) combines optical contrast with ultrasonic resolution, achieving deep-tissue imaging beyond the optical diffusion limit. While three-dimensional PACT systems enable high-resolution volumetric imaging for applications spanning transcranial to breast imaging, current implementations require dense transducer arrays and prolonged acquisition times, limiting clinical translation. We introduce Pano (PACT imaging neural operator), an end-to-end physics-aware model that directly learns the inverse acoustic mapping from sensor measurements to volumetric reconstructions. Unlike existing approaches (e.g. universal back-projection algorithm), Pano learns both physics and data priors while also being agnostic to the input data resolution. Pano employs spherical discrete-continuous convolutions to preserve hemispherical sensor geometry, incorporates Helmholtz equation constraints to ensure physical consistency and operates resolutionindependently across varying sensor configurations. We demonstrate the robustness and efficiency of Pano in reconstructing high-quality images from both simulated and real experimental data, achieving consistent performance even with significantly reduced transducer counts and limited-angle acquisition configurations. The framework maintains reconstruction fidelity across diverse sparse sampling patterns while enabling real-time volumetric imaging capabilities. This advancement establishes a practical pathway for making 3D PACT more accessible and feasible for both preclinical research and clinical applications, substantially reducing hardware requirements without compromising image reconstruction quality.

--Accurate and efficient simulation of wave equations is crucial in computational wave imaging applications, such as ultrasound computed tomography (USCT), which reconstructs tissue material properties from observed scattered waves. Traditional numerical solvers for wave equations are computationally intensive and often unstable, limiting their practical applications for quasi-real-time image reconstruction. Neural operators offer an innovative approach by accelerating PDE solving using neural networks; however, their effectiveness in realistic imaging is limited because existing datasets oversimplify real-world complexity. In this paper, we present OpenBreastUS, a large-scale wave equation dataset designed to bridge the gap between theoretical equations and practical imaging applications. OpenBreastUS includes 8,000 anatomically realistic human breast phantoms and over 16 million frequency-domain wave simulations using real USCT configurations. It enables a comprehensive benchmarking of popular neural operators for both forward simulation and inverse imaging tasks, allowing analysis of their performance, scalability, and generalization capabilities. By offering a realistic and extensive dataset, OpenBreastUS not only serves as a platform for developing innovative neural PDE solvers but also facilitates their deployment in real-world medical imaging problems. For the first time, we demonstrate efficient in vivo imaging of the human breast using neural operator solvers. Zhijun Zeng is with the Department of Mathematical Sciences, Tsinghua University, Beijing 100084, China (e-mail: zengzj22@mails.tsinghua.edu.cn).

Artifacts in kilo-Voltage CT (kVCT) imaging degrade image quality, impacting clinical decisions. We propose a deep learning framework for metal artifact reduction (MAR) and domain transformation from kVCT to Mega-Voltage CT (MVCT). The proposed framework, ReMAR-DS, utilizes an encoder-decoder architecture with enhanced feature recalibration, effectively reducing artifacts while preserving anatomical structures. This ensures that only relevant information is utilized in the reconstruction process. By infusing recalibrated features from the encoder block, the model focuses on relevant spatial regions (e.g., areas with artifacts) and highlights key features across channels (e.g., anatomical structures), leading to improved reconstruction of artifact-corrupted regions. Unlike traditional MAR methods, our approach bridges the gap between high-resolution kVCT and artifact-resistant MVCT, enhancing radiotherapy planning. It produces high-quality MVCT-like reconstructions, validated through qualitative and quantitative evaluations. Clinically, this enables oncologists to rely on kVCT alone, reducing repeated high-dose MVCT scans and lowering radiation exposure for cancer patients.

We introduce a novel deep learning framework for the automated staging of spheno-occipital synchondrosis (SOS) fusion, a critical diagnostic marker in both orthodontics and forensic anthropology. Our approach leverages a dual-model architecture wherein a teacher model, trained on manually cropped images, transfers its precise spatial understanding to a student model that operates on full, uncropped images. This knowledge distillation is facilitated by a newly formulated loss function that aligns spatial logits as well as incorporates gradient-based attention spatial mapping, ensuring that the student model internalizes the anatomically relevant features without relying on external cropping or YOLO-based segmentation. By leveraging expert-curated data and feedback at each step, our framework attains robust diagnostic accuracy, culminating in a clinically viable end-to-end pipeline. This streamlined approach obviates the need for additional pre-processing tools and accelerates deployment, thereby enhancing both the efficiency and consistency of skeletal maturation assessment in diverse clinical settings.

Diffusion models demonstrate state-of-the-art performance on image generation, and are gaining traction for sparse medical image reconstruction tasks. However, compared to classical reconstruction algorithms relying on simple analytical priors, diffusion models have the dangerous property of producing realistic looking results \emph{even when incorrect}, particularly with few observations. We investigate the utility of diffusion models as priors for image reconstruction by varying the number of observations and comparing their performance to classical priors (sparse and Tikhonov regularization) using pixel-based, structural, and downstream metrics. We make comparisons on low-dose chest wall computed tomography (CT) for fat mass quantification. First, we find that classical priors are superior to diffusion priors when the number of projections is ``sufficient''. Second, we find that diffusion priors can capture a large amount of detail with very few observations, significantly outperforming classical priors. However, they fall short of capturing all details, even with many observations. Finally, we find that the performance of diffusion priors plateau after extremely few ($\approx$10-15) projections. Ultimately, our work highlights potential issues with diffusion-based sparse reconstruction and underscores the importance of further investigation, particularly in high-stakes clinical settings.

Cracks in concrete structures are very common and are an integral part of this heterogeneous material. Characteristics of cracks induced by standardized tests yield valuable information about the tested concrete formulation and its mechanical properties. Observing cracks on the surface of the concrete structure leaves a wealth of structural information unused. Computed tomography enables looking into the sample without interfering or destroying the microstructure. The reconstructed tomographic images are 3d images, consisting of voxels whose gray values represent local X-ray absorption. In order to identify voxels belonging to the crack, so to segment the crack structure in the images, appropriate algorithms need to be developed. Convolutional neural networks are known to solve this type of task very well given enough and consistent training data. We adapted a 3d version of the well-known U-Net and trained it on semi-synthetic 3d images of real concrete samples equipped with simulated crack structures. Here, we explain the general approach. Moreover, we show how to teach the network to detect also real crack systems in 3d images of varying types of real concrete, in particular of fiber reinforced concrete.

In certain three-dimensional (3D) applications of photoacoustic computed tomography (PACT), including \textit{in vivo} breast imaging, hemispherical measurement apertures that enclose the object within their convex hull are employed for data acquisition. Data acquired with such measurement geometries are referred to as \textit{half-scan} data, as only half of a complete spherical measurement aperture is employed. Although previous studies have demonstrated that half-scan data can uniquely and stably reconstruct the sought-after object, no closed-form reconstruction formula for use with half-scan data has been reported. To address this, a semi-analytic reconstruction method in the form of filtered backprojection (FBP), referred to as the half-scan FBP method, is developed in this work. Because the explicit form of the filtering operation in the half-scan FBP method is not currently known, a learning-based method is proposed to approximate it. The proposed method is systematically investigated by use of virtual imaging studies of 3D breast PACT that employ ensembles of numerical breast phantoms and a physics-based model of the data acquisition process. The method is subsequently applied to experimental data acquired in an \textit{in vivo} breast PACT study. The results confirm that the half-scan FBP method can accurately reconstruct 3D images from half-scan data. Importantly, because the sought-after inverse mapping is well-posed, the reconstruction method remains accurate even when applied to data that differ considerably from those employed to learn the filtering operation.