Low-dose computed tomography (LDCT) lower potential risks linked to radiation exposure while relying on advanced denoising algorithms to maintain diagnostic quality in reconstructed images. The reigning paradigm in LDCT denoising is based on neural network models that learn data-driven image priors to separate noise evoked by dose reduction from underlying tissue signals. Naturally, the fidelity of these priors depend on the model's ability to capture the broad range of contextual features evident in CT images. Earlier convolutional neural networks (CNN) are highly adept at efficiently capturing short-range spatial context, but their limited receptive fields reduce sensitivity to interactions over longer distances. Although transformers based on self-attention mechanisms have recently been posed to increase sensitivity to long-range context, they can suffer from suboptimal performance and efficiency due to elevated model complexity, particularly for high-resolution CT images. For high-quality restoration of LDCT images, here we introduce DenoMamba, a novel denoising method based on state-space modeling (SSM), that efficiently captures short- and long-range context in medical images. Following an hourglass architecture with encoder-decoder stages, DenoMamba employs a spatial SSM module to encode spatial context and a novel channel SSM module equipped with a secondary gated convolution network to encode latent features of channel context at each stage. Feature maps from the two modules are then consolidated with low-level input features via a convolution fusion module (CFM). Comprehensive experiments on LDCT datasets with 25\% and 10\% dose reduction demonstrate that DenoMamba outperforms state-of-the-art denoisers with average improvements of 1.4dB PSNR, 1.1% SSIM, and 1.6% RMSE in recovered image quality.

Low-dose computed tomography (LDCT) has become the technology of choice for diagnostic medical imaging, given its lower radiation dose compared to standard CT, despite increasing image noise and potentially affecting diagnostic accuracy. To address this, advanced deep learning-based LDCT denoising algorithms have been developed, primarily using Convolutional Neural Networks (CNNs) or Transformer Networks with the Unet architecture. This architecture enhances image detail by integrating feature maps from the encoder and decoder via skip connections. However, current methods often overlook enhancements to the Unet architecture itself, focusing instead on optimizing encoder and decoder structures. This approach can be problematic due to the significant differences in feature map characteristics between the encoder and decoder, where simple fusion strategies may not effectively reconstruct images.In this paper, we introduce WiTUnet, a novel LDCT image denoising method that utilizes nested, dense skip pathways instead of traditional skip connections to improve feature integration. WiTUnet also incorporates a windowed Transformer structure to process images in smaller, non-overlapping segments, reducing computational load. Additionally, the integration of a Local Image Perception Enhancement (LiPe) module in both the encoder and decoder replaces the standard multi-layer perceptron (MLP) in Transformers, enhancing local feature capture and representation. Through extensive experimental comparisons, WiTUnet has demonstrated superior performance over existing methods in key metrics such as Peak Signal-to-Noise Ratio (PSNR), Structural Similarity (SSIM), and Root Mean Square Error (RMSE), significantly improving noise removal and image quality.

Generative Adversarial Networks (GANs) have proved as a powerful framework for denoising applications in medical imaging. However, GAN-based denoising algorithms still suffer from limitations in capturing complex relationships within the images. In this regard, the loss function plays a crucial role in guiding the image generation process, encompassing how much a synthetic image differs from a real image. To grasp highly complex and non-linear textural relationships in the training process, this work presents a loss function that leverages the intrinsic multi-scale nature of the Gray-Level-Co-occurrence Matrix (GLCM). Although the recent advances in deep learning have demonstrated superior performance in classification and detection tasks, we hypothesize that its information content can be valuable when integrated into GANs' training. To this end, we propose a differentiable implementation of the GLCM suited for gradient-based optimization. Our approach also introduces a self-attention layer that dynamically aggregates the multi-scale texture information extracted from the images. We validate our approach by carrying out extensive experiments in the context of low-dose CT denoising, a challenging application that aims to enhance the quality of noisy CT scans. We utilize three publicly available datasets, including one simulated and two real datasets. The results are promising as compared to other well-established loss functions, being also consistent across three different GAN architectures. The code is available at: https://github.com/FrancescoDiFeola/DenoTextureLoss

Deep learning (DL) has made significant advancements in tomographic imaging, particularly in low-dose computed tomography (LDCT) denoising. A recent trend involves servers training powerful models with large amounts of self-collected private data and providing application programming interfaces (APIs) for users, such as Chat-GPT. To avoid model leakage, users are required to upload their data to the server model, but this way raises public concerns about the potential risk of privacy disclosure, especially for medical data. Hence, to alleviate related concerns, in this paper, we propose to directly denoise LDCT in the encrypted domain to achieve privacy-preserving cloud services without exposing private data to the server. To this end, we employ homomorphic encryption to encrypt private LDCT data, which is then transferred to the server model trained with plaintext LDCT for further denoising. However, since traditional operations, such as convolution and linear transformation, in DL methods cannot be directly used in the encrypted domain, we transform the fundamental mathematic operations in the plaintext domain into the operations in the encrypted domain. In addition, we present two interactive frameworks for linear and nonlinear models in this paper, both of which can achieve lossless operating. In this way, the proposed methods can achieve two merits, the data privacy is well protected and the server model is free from the risk of model leakage. Moreover, we provide theoretical proof to validate the lossless property of our framework. Finally, experiments were conducted to demonstrate that the transferred contents are well protected and cannot be reconstructed. The code will be released once the paper is accepted.

Low-dose computed tomography (CT) images suffer from noise and artifacts due to photon starvation and electronic noise. Recently, some works have attempted to use diffusion models to address the over-smoothness and training instability encountered by previous deep-learning-based denoising models. However, diffusion models suffer from long inference times due to the large number of sampling steps involved. Very recently, cold diffusion model generalizes classical diffusion models and has greater flexibility. Inspired by the cold diffusion, this paper presents a novel COntextual eRror-modulated gEneralized Diffusion model for low-dose CT (LDCT) denoising, termed CoreDiff. First, CoreDiff utilizes LDCT images to displace the random Gaussian noise and employs a novel mean-preserving degradation operator to mimic the physical process of CT degradation, significantly reducing sampling steps thanks to the informative LDCT images as the starting point of the sampling process. Second, to alleviate the error accumulation problem caused by the imperfect restoration operator in the sampling process, we propose a novel ContextuaL Error-modulAted Restoration Network (CLEAR-Net), which can leverage contextual information to constrain the sampling process from structural distortion and modulate time step embedding features for better alignment with the input at the next time step. Third, to rapidly generalize to a new, unseen dose level with as few resources as possible, we devise a one-shot learning framework to make CoreDiff generalize faster and better using only a single LDCT image (un)paired with NDCT. Extensive experimental results on two datasets demonstrate that our CoreDiff outperforms competing methods in denoising and generalization performance, with a clinically acceptable inference time. Source code is made available at https://github.com/qgao21/CoreDiff.

In this work, we tackle the problem of robust computed tomography (CT) reconstruction issue under a cross-domain scenario, i.e., the training CT data as the source domain and the testing CT data as the target domain are collected from different anatomical regions. Due to the mismatches of the scan region and corresponding scan protocols, there is usually a difference of noise distributions between source and target domains (a.k.a. noise distribution shifts), resulting in a catastrophic deterioration of the reconstruction performance on target domain. To render a robust cross-domain CT reconstruction performance, instead of using deterministic models (e.g., convolutional neural network), a Bayesian-endowed probabilistic framework is introduced into robust cross-domain CT reconstruction task due to its impressive robustness. Under this probabilistic framework, we propose to alleviate the noise distribution shifts between source and target domains via implicit noise modeling schemes in the latent space and image space, respectively. Specifically, a novel Bayesian noise uncertainty alignment (BNUA) method is proposed to conduct implicit noise distribution modeling and alignment in the latent space. Moreover, an adversarial learning manner is imposed to reduce the discrepancy of noise distribution between two domains in the image space via a novel residual distribution alignment (RDA). Extensive experiments on the head and abdomen scans show that our proposed method can achieve a better performance of robust cross-domain CT reconstruction than existing approaches in terms of both quantitative and qualitative results.

Deep learning has been successfully applied to low-dose CT (LDCT) image denoising for reducing potential radiation risk. However, the widely reported supervised LDCT denoising networks require a training set of paired images, which is expensive to obtain and cannot be perfectly simulated. Unsupervised learning utilizes unpaired data and is highly desirable for LDCT denoising. As an example, an artifact disentanglement network (ADN) relies on unparied images and obviates the need for supervision but the results of artifact reduction are not as good as those through supervised learning.An important observation is that there is often hidden similarity among unpaired data that can be utilized. This paper introduces a new learning mode, called quasi-supervised learning, to empower the ADN for LDCT image denoising.For every LDCT image, the best matched image is first found from an unpaired normal-dose CT (NDCT) dataset. Then, the matched pairs and the corresponding matching degree as prior information are used to construct and train our ADN-type network for LDCT denoising.The proposed method is different from (but compatible with) supervised and semi-supervised learning modes and can be easily implemented by modifying existing networks. The experimental results show that the method is competitive with state-of-the-art methods in terms of noise suppression and contextual fidelity. The code and working dataset are publicly available at https://github.com/ruanyuhui/ADN-QSDL.git.

Low-dose computed tomography (LDCT) reduces the X-ray radiation but compromises image quality with more noises and artifacts. A plethora of transformer models have been developed recently to improve LDCT image quality. However, the success of a transformer model relies on a large amount of paired noisy and clean data, which is often unavailable in clinical applications. In computer vision and natural language processing fields, masked autoencoders (MAE) have been proposed as an effective label-free self-pretraining method for transformers, due to its excellent feature representation ability. Here, we redesign the classical encoder-decoder learning model to match the denoising task and apply it to LDCT denoising problem. The MAE can leverage the unlabeled data and facilitate structural preservation for the LDCT denoising model when ground truth data are missing. Experiments on the Mayo dataset validate that the MAE can boost the transformer's denoising performance and relieve the dependence on the ground truth data.

Deep learning has achieved notable performance in the denoising task of low-quality medical images and the detection task of lesions, respectively. However, existing low-quality medical image denoising approaches are disconnected from the detection task of lesions. Intuitively, the quality of denoised images will influence the lesion detection accuracy that in turn can be used to affect the denoising performance. To this end, we propose a play-and-plug medical image denoising framework, namely Lesion-Inspired Denoising Network (LIDnet), to collaboratively improve both denoising performance and detection accuracy of denoised medical images. Specifically, we propose to insert the feedback of downstream detection task into existing denoising framework by jointly learning a multi-loss objective. Instead of using perceptual loss calculated on the entire feature map, a novel region-of-interest (ROI) perceptual loss induced by the lesion detection task is proposed to further connect these two tasks. To achieve better optimization for overall framework, we propose a customized collaborative training strategy for LIDnet. On consideration of clinical usability and imaging characteristics, three low-dose CT images datasets are used to evaluate the effectiveness of the proposed LIDnet. Experiments show that, by equipping with LIDnet, both of the denoising and lesion detection performance of baseline methods can be significantly improved.

Computed tomography (CT) is a popular medical imaging modality in clinical applications. At the same time, the x-ray radiation dose associated with CT scans raises public concerns due to its potential risks to the patients. Over the past years, major efforts have been dedicated to the development of Low-Dose CT (LDCT) methods. However, the radiation dose reduction compromises the signal-to-noise ratio (SNR), leading to strong noise and artifacts that down-grade CT image quality. In this paper, we propose a novel 3D noise reduction method, called Structure-sensitive Multi-scale Generative Adversarial Net (SMGAN), to improve the LDCT image quality. Specifically, we incorporate three-dimensional (3D) volumetric information to improve the image quality. Also, different loss functions for training denoising models are investigated. Experiments show that the proposed method can effectively preserve structural and texture information from normal-dose CT (NDCT) images, and significantly suppress noise and artifacts. Qualitative visual assessments by three experienced radiologists demonstrate that the proposed method retrieves more detailed information, and outperforms competing methods.