Michele Avanzo

Belén Serrano-Antón, Mubashara Rehman, Niki Martinel et al.

For the planning of radiotherapy treatments for head and neck cancers, Computed Tomography (CT) scans of the patients are typically employed. However, in patients with head and neck cancer, the quality of standard CT scans generated using kilo-Voltage (kVCT) tube potentials is severely degraded by streak artifacts occurring in the presence of metallic implants such as dental fillings. Some radiotherapy devices offer the possibility of acquiring Mega-Voltage CT (MVCT) for daily patient setup verification, due to the higher energy of X-rays used, MVCT scans are almost entirely free from artifacts making them more suitable for radiotherapy treatment planning. In this study, we leverage the advantages of kVCT scans with those of MVCT scans (artifact-free). We propose a deep learning-based approach capable of generating artifact-free MVCT images from acquired kVCT images. The outcome offers the benefits of artifact-free MVCT images with enhanced soft tissue contrast, harnessing valuable information obtained through kVCT technology for precise therapy calibration. Our proposed method employs UNet-inspired model, and is compared with adversarial learning and transformer networks. This first and unique approach achieves remarkable success, with PSNR of 30.02 dB across the entire patient volume and 27.47 dB in artifact-affected regions exclusively. It is worth noting that the PSNR calculation excludes the background, concentrating solely on the region of interest.

Mubashara Rehman, Niki Martinel, Michele Avanzo et al.

Metal artifacts in computed tomography (CT) severely degrade image quality, compromising diagnostic accuracy and radiotherapy planning, especially in cancer patients with high-density implants. We propose H3D-MarNet, a two-stage framework for artifact-aware CT domain transformation from kilo-voltage CT (kVCT) to mega-voltage CT (MVCT). In the first stage, a wavelet-based preprocessing module suppresses metal-induced artifacts through frequency-aware denoising while preserving anatomical structures. In second stage, Domain-TransNet performs kVCT-to-MVCT domain transformation using a hybrid volumetric learning architecture. Domain-TransNet integrates a CNN-based encoder to capture fine-grained local anatomical details and a transformer-based encoder to model long-range volumetric dependencies. The complementary representations are fused through an attention-based feature fusion mechanism to ensure spatial and contextual coherence across slices. A multi-stage, attention-guided decoder, supported by deep supervision, progressively reconstructs artifact-suppressed MVCT volumes. Extensive experiments demonstrate that H3D-MarNet achieves 28.14 dB PSNR and 0.717 SSIM on artifact-affected slices from full dataset, indicating effective metal artifact suppression and anatomical preservation, highlighting its potential for reliable CT modality transformation in clinical radiotherapy workflows.

Mubashara Rehman, Niki Martinel, Michele Avanzo et al.

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.