Siyuan Mei

Mengchen Fan, Baocheng Geng, Xi Xiao et al.

Deploying high-performing 3D medical image segmenters (e.g., nnU-Net) is often limited by memory footprint and inference latency. Compression is therefore necessary, but compact 3D encoders tend to lose fine structural cues (small lesions and sharp boundaries) as downsampling repeats across multi-resolution stages. We propose Detail Consistent Distillation (DCD), a stage-wise distillation framework that preserves structural detail across scales by aligning teacher-student features in a wavelet-decomposed representation. At each encoder stage, DCD distills directional detail components in the wavelet domain while leaving the coarse approximation comparatively unconstrained, avoiding over-regularization of global semantics. DCD is used only during training and introduces no inference-time overhead. Experiments on the BraTS 2024 and ISLES 2022 benchmarks demonstrate that our approach achieves superior performance in MRI segmentation using 3D multi-modal data. Code and implementation details for DCD are publicly available at https://github.com/ClinicaAlpha/DCD-3D-MedSeg.

Siyuan Mei, Fuxin Fan, Andreas Maier

During orthopaedic surgery, the inserting of metallic implants or screws are often performed under mobile C-arm systems. Due to the high attenuation of metals, severe metal artifacts occur in 3D reconstructions, which degrade the image quality greatly. To reduce the artifacts, many metal artifact reduction algorithms have been developed and metal inpainting in projection domain is an essential step. In this work, a score-based generative model is trained on simulated knee projections and the inpainted image is obtained by removing the noise in conditional resampling process. The result implies that the inpainted images by score-based generative model have more detailed information and achieve the lowest mean absolute error and the highest peak-signal-to-noise-ratio compared with interpolation and CNN based method. Besides, the score-based model can also recover projections with big circlar and rectangular masks, showing its generalization in inpainting task.

Mareike Thies, Fabian Wagner, Mingxuan Gu et al.

Intravital X-ray microscopy (XRM) in preclinical mouse models is of vital importance for the identification of microscopic structural pathological changes in the bone which are characteristic of osteoporosis. The complexity of this method stems from the requirement for high-quality 3D reconstructions of the murine bones. However, respiratory motion and muscle relaxation lead to inconsistencies in the projection data which result in artifacts in uncompensated reconstructions. Motion compensation using epipolar consistency conditions (ECC) has previously shown good performance in clinical CT settings. Here, we explore whether such algorithms are suitable for correcting motion-corrupted XRM data. Different rigid motion patterns are simulated and the quality of the motion-compensated reconstructions is assessed. The method is able to restore microscopic features for out-of-plane motion, but artifacts remain for more realistic motion patterns including all six degrees of freedom of rigid motion. Therefore, ECC is valuable for the initial alignment of the projection data followed by further fine-tuning of motion parameters using a reconstruction-based method.

Daiqi Liu, Lukas Mulzer, Md Hasan et al.

Segmenting vocal tract articulators in real-time MRI (rtMRI) is a challenging dynamic image segmentation problem characterized by low contrast, rapid motion, and limited spatial resolution. However, while rtMRI acquisitions may provide synchronized acoustic signals, existing methods discard this information, and the few multimodal approaches that incorporate audio cannot be deployed when audio is unavailable. We propose a three-stage framework that leverages acoustic and phonological supervision during training while requiring only the rtMRI image at inference: phonological representations are converted into spatial bounding-box priors for articulator localization, visual and acoustic encoders are aligned via dual-level cross-modal contrastive pretraining, and the learned representations are fused through a cross-attention decoder, effectively transferring multimodal knowledge into a single-modality inference pipeline. Evaluated on 75-Speaker~Annot-16 and USC-TIMIT datasets, our method outperforms existing unimodal and multimodal methods, demonstrating that multimodal supervision provides transferable benefits for precise and clinically deployable vocal tract segmentation.

Yipeng Sun, Yixing Huang, Linda-Sophie Schneider et al.

Computed Tomography (CT) image reconstruction is crucial for accurate diagnosis and deep learning approaches have demonstrated significant potential in improving reconstruction quality. However, the choice of loss function profoundly affects the reconstructed images. Traditional mean squared error loss often produces blurry images lacking fine details, while alternatives designed to improve may introduce structural artifacts or other undesirable effects. To address these limitations, we propose Eagle-Loss, a novel loss function designed to enhance the visual quality of CT image reconstructions. Eagle-Loss applies spectral analysis of localized features within gradient changes to enhance sharpness and well-defined edges. We evaluated Eagle-Loss on two public datasets across low-dose CT reconstruction and CT field-of-view extension tasks. Our results show that Eagle-Loss consistently improves the visual quality of reconstructed images, surpassing state-of-the-art methods across various network architectures. Code and data are available at \url{https://github.com/sypsyp97/Eagle_Loss}.

Yipeng Sun, Linda-Sophie Schneider, Fuxin Fan et al.

In this study, we introduce a Fourier series-based trainable filter for computed tomography (CT) reconstruction within the filtered backprojection (FBP) framework. This method overcomes the limitation in noise reduction by optimizing Fourier series coefficients to construct the filter, maintaining computational efficiency with minimal increment for the trainable parameters compared to other deep learning frameworks. Additionally, we propose Gaussian edge-enhanced (GEE) loss function that prioritizes the $L_1$ norm of high-frequency magnitudes, effectively countering the blurring problems prevalent in mean squared error (MSE) approaches. The model's foundation in the FBP algorithm ensures excellent interpretability, as it relies on a data-driven filter with all other parameters derived through rigorous mathematical procedures. Designed as a plug-and-play solution, our Fourier series-based filter can be easily integrated into existing CT reconstruction models, making it an adaptable tool for a wide range of practical applications. Code and data are available at https://github.com/sypsyp97/Trainable-Fourier-Series.

Viktor Rogowski, Maarten L. Terpstra, Niklas Wahl et al.

Radiation therapy (RT) requires precise dose delivery over multiple fractions, with CT fundamental for treatment planning due to its electron density information. Repeated CT acquisitions impose radiation exposure and logistical burdens, MRI lacks electron density, and cone-beam CT (CBCT) requires correction for dose calculation. Synthetic CT (sCT) generation addresses these by converting MRI or CBCT into CT-equivalent images with accurate Hounsfield Unit (HU) values, enabling MRI-only RT and CBCT-based adaptive workflows. Building on SynthRAD2023, SynthRAD2025 benchmarked sCT methods on 2,362 patients from five European centers across head and neck, thorax, and abdomen. Two tasks: MRI-to-CT (890 cases) and CBCT-to-CT (1,472 cases), evaluated via image similarity (MAE, PSNR, MS-SSIM), segmentation (Dice, HD95), and dosimetric metrics from photon and proton plans. With 803 participants and 12/13 valid submissions, Task 1 top performance reached MAE $64.8\pm21.3$ HU, PSNR $\sim$30 dB, MS-SSIM $\sim$0.936, Dice 0.79, photon $γ_{2\%/2\text{mm}}>98\%$, proton $γ\approx85\%$. Task 2 improved: MAE $48.3\pm13.4$ HU, PSNR 32.6 dB, MS-SSIM 0.968, Dice 0.86, photon $γ>99\%$, proton $γ\approx89\%$. Strong image--segmentation correlations ($ρ=0.78$--$0.79$) but moderate dose correlations confirmed image quality is insufficient as a dosimetric surrogate. Head-and-neck cases were most consistent; thoracic and abdominal cases showed greater variability. Residual errors at tissue interfaces propagate along beam paths, affecting proton dose more than photon. SynthRAD2025 demonstrates that deep learning yields clinically relevant sCTs, especially for CBCT-to-CT, while identifying persistent MRI-to-CT challenges and underscoring dose-based evaluation as essential for clinical validation.

Siyuan Mei, Yan Xia, Fuxin Fan

The synthesis of computed tomography (CT) from magnetic resonance imaging (MRI) and cone-beam CT (CBCT) plays a critical role in clinical treatment planning by enabling accurate anatomical representation in adaptive radiotherapy. In this work, we propose GANeXt, a 3D patch-based, fully ConvNeXt-powered generative adversarial network for unified CT synthesis across different modalities and anatomical regions. Specifically, GANeXt employs an efficient U-shaped generator constructed from stacked 3D ConvNeXt blocks with compact convolution kernels, while the discriminator adopts a conditional PatchGAN. To improve synthesis quality, we incorporate a combination of loss functions, including mean absolute error (MAE), perceptual loss, segmentation-based masked MAE, and adversarial loss and a combination of Dice loss and cross-entropy for multi-head segmentation discriminator. For both tasks, training is performed with a batch size of 8 using two separate AdamW optimizers for the generator and discriminator, each equipped with a warmup and cosine decay scheduler, with learning rates of $5\times10^{-4}$ and $1\times10^{-3}$, respectively. Data preprocessing includes deformable registration, foreground cropping, percentile normalization for the input modality, and linear normalization of the CT to the range $[-1024, 1000]$. Data augmentation involves random zooming within $(0.8, 1.3)$ (for MRI-to-CT only), fixed-size cropping to $32\times160\times192$ for MRI-to-CT and $32\times128\times128$ for CBCT-to-CT, and random flipping. During inference, we apply a sliding-window approach with $0.8$ overlap and average folding to reconstruct the full-size sCT, followed by inversion of the CT normalization. After joint training on all regions without any fine-tuning, the final models are selected at the end of 3000 epochs for MRI-to-CT and 1000 epochs for CBCT-to-CT using the full training dataset.

Yipeng Sun, Linda-Sophie Schneider, Mingxuan Gu et al.

Effective denoising is crucial in low-dose CT to enhance subtle structures and low-contrast lesions while preventing diagnostic errors. Supervised methods struggle with limited paired datasets, and self-supervised approaches often require multiple noisy images and rely on deep networks like U-Net, offering little insight into the denoising mechanism. To address these challenges, we propose an interpretable self-supervised single-image denoising framework -- Filter2Noise (F2N). Our approach introduces an Attention-Guided Bilateral Filter that adapted to each noisy input through a lightweight module that predicts spatially varying filter parameters, which can be visualized and adjusted post-training for user-controlled denoising in specific regions of interest. To enable single-image training, we introduce a novel downsampling shuffle strategy with a new self-supervised loss function that extends the concept of Noise2Noise to a single image and addresses spatially correlated noise. On the Mayo Clinic 2016 low-dose CT dataset, F2N outperforms the leading self-supervised single-image method (ZS-N2N) by 4.59 dB PSNR while improving transparency, user control, and parametric efficiency. These features provide key advantages for medical applications that require precise and interpretable noise reduction. Our code is demonstrated at https://github.com/sypsyp97/Filter2Noise.git .

Zirong Li, Siyuan Mei, Weiwen Wu et al.

Conditional medical image generation plays an important role in many clinically relevant imaging tasks. However, existing methods still face a fundamental challenge in balancing inference efficiency, patient-specific fidelity, and distribution-level plausibility, particularly in high-dimensional 3D medical imaging. In this work, we propose GDM, a generative drifting framework that reformulates deterministic medical image prediction as a multi-objective learning problem to jointly promote distribution-level plausibility and patient-specific fidelity while retaining one-step inference. GDM extends drifting to 3D medical imaging through an attractive-repulsive drift that minimizes the discrepancy between the generator pushforward and the target distribution. To enable stable drifting-based learning in 3D volumetric data, GDM constructs a multi-level feature bank from a medical foundation encoder to support reliable affinity estimation and drifting field computation across complementary global, local, and spatial representations. In addition, a gradient coordination strategy in the shared output space improves optimization balance under competing distribution-level and fidelity-oriented objectives. We evaluate the proposed framework on two representative tasks, MRI-to-CT synthesis and sparse-view CT reconstruction. Experimental results show that GDM consistently outperforms a wide range of baselines, including GAN-based, flow-matching-based, and SDE-based generative models, as well as supervised regression methods, while improving the balance among anatomical fidelity, quantitative reliability, perceptual realism, and inference efficiency. These findings suggest that GDM provides a practical and effective framework for conditional 3D medical image generation.

Mareike Thies, Fabian Wagner, Noah Maul et al.

Cone-beam computed tomography (CBCT) systems, with their flexibility, present a promising avenue for direct point-of-care medical imaging, particularly in critical scenarios such as acute stroke assessment. However, the integration of CBCT into clinical workflows faces challenges, primarily linked to long scan duration resulting in patient motion during scanning and leading to image quality degradation in the reconstructed volumes. This paper introduces a novel approach to CBCT motion estimation using a gradient-based optimization algorithm, which leverages generalized derivatives of the backprojection operator for cone-beam CT geometries. Building on that, a fully differentiable target function is formulated which grades the quality of the current motion estimate in reconstruction space. We drastically accelerate motion estimation yielding a 19-fold speed-up compared to existing methods. Additionally, we investigate the architecture of networks used for quality metric regression and propose predicting voxel-wise quality maps, favoring autoencoder-like architectures over contracting ones. This modification improves gradient flow, leading to more accurate motion estimation. The presented method is evaluated through realistic experiments on head anatomy. It achieves a reduction in reprojection error from an initial average of 3mm to 0.61mm after motion compensation and consistently demonstrates superior performance compared to existing approaches. The analytic Jacobian for the backprojection operation, which is at the core of the proposed method, is made publicly available. In summary, this paper contributes to the advancement of CBCT integration into clinical workflows by proposing a robust motion estimation approach that enhances efficiency and accuracy, addressing critical challenges in time-sensitive scenarios.

Chengze Ye, Linda-Sophie Schneider, Yipeng Sun et al.

This paper introduces a novel method for reconstructing cone beam computed tomography (CBCT) images for arbitrary orbits using a differentiable shift-variant filtered backprojection (FBP) neural network. Traditional CBCT reconstruction methods for arbitrary orbits, like iterative reconstruction algorithms, are computationally expensive and memory-intensive. The proposed method addresses these challenges by employing a shift-variant FBP algorithm optimized for arbitrary trajectories through a deep learning approach that adapts to a specific orbit geometry. This approach overcomes the limitations of existing techniques by integrating known operators into the learning model, minimizing the number of parameters, and improving the interpretability of the model. The proposed method is a significant advancement in interventional medical imaging, particularly for robotic C-arm CT systems, enabling faster and more accurate CBCT reconstructions with customized orbits. Especially this method can also be used for the analytical reconstruction of non-continuous orbits like circular plus arc. The experimental results demonstrate that the proposed method significantly accelerates the reconstruction process compared to conventional iterative algorithms. It achieves comparable or superior image quality, as evidenced by metrics such as the mean squared error (MSE), the peak signal-to-noise ratio (PSNR), and the structural similarity index measure (SSIM). The validation experiments show that the method can handle data from different trajectories, demonstrating its flexibility and robustness across different scan geometries. Our method demonstrates a significant improvement, particularly for the sinusoidal trajectory, achieving a 38.6% reduction in MSE, a 7.7% increase in PSNR, and a 5.0% improvement in SSIM. Furthermore, the computation time for reconstruction was reduced by more than 97%.

Mathias Öttl, Siyuan Mei, Frauke Wilm et al.

Denoising Diffusion Probabilistic models have become increasingly popular due to their ability to offer probabilistic modeling and generate diverse outputs. This versatility inspired their adaptation for image segmentation, where multiple predictions of the model can produce segmentation results that not only achieve high quality but also capture the uncertainty inherent in the model. Here, powerful architectures were proposed for improving diffusion segmentation performance. However, there is a notable lack of analysis and discussions on the differences between diffusion segmentation and image generation, and thorough evaluations are missing that distinguish the improvements these architectures provide for segmentation in general from their benefit for diffusion segmentation specifically. In this work, we critically analyse and discuss how diffusion segmentation for medical images differs from diffusion image generation, with a particular focus on the training behavior. Furthermore, we conduct an assessment how proposed diffusion segmentation architectures perform when trained directly for segmentation. Lastly, we explore how different medical segmentation tasks influence the diffusion segmentation behavior and the diffusion process could be adapted accordingly. With these analyses, we aim to provide in-depth insights into the behavior of diffusion segmentation that allow for a better design and evaluation of diffusion segmentation methods in the future.

Siyuan Mei, Fuxin Fan, Mareike Thies et al.

Recently, X-ray microscopy (XRM) and light-sheet fluorescence microscopy (LSFM) have emerged as pivotal tools in preclinical research, particularly for studying bone remodeling diseases such as osteoporosis. These modalities offer micrometer-level resolution, and their integration allows for a complementary examination of bone microstructures which is essential for analyzing functional changes. However, registering high-resolution volumes from these independently scanned modalities poses substantial challenges, especially in real-world and reference-free scenarios. This paper presents BigReg, a fast, two-stage pipeline designed for large-volume registration of XRM and LSFM data. The first stage involves extracting surface features and applying two successive point cloud-based methods for coarse alignment. The subsequent stage refines this alignment using a modified cross-correlation technique, achieving precise volumetric registration. Evaluations using expert-annotated landmarks and augmented test data demonstrate that BigReg approaches the accuracy of landmark-based registration with a landmark distance (LMD) of 8.36\,\textmu m\,$\pm$\,0.12\,\textmu m and a landmark fitness (LM fitness) of 85.71\%\,$\pm$\,1.02\%. Moreover, BigReg can provide an optimal initialization for mutual information-based methods which otherwise fail independently, further reducing LMD to 7.24\,\textmu m\,$\pm$\,0.11\,\textmu m and increasing LM fitness to 93.90\%\,$\pm$\,0.77\%. Ultimately, key microstructures, notably lacunae in XRM and bone cells in LSFM, are accurately aligned, enabling unprecedented insights into the pathology of osteoporosis.

Mareike Thies, Noah Maul, Siyuan Mei et al.

Motion artifacts can compromise the diagnostic value of computed tomography (CT) images. Motion correction approaches require a per-scan estimation of patient-specific motion patterns. In this work, we train a score-based model to act as a probability density estimator for clean head CT images. Given the trained model, we quantify the deviation of a given motion-affected CT image from the ideal distribution through likelihood computation. We demonstrate that the likelihood can be utilized as a surrogate metric for motion artifact severity in the CT image facilitating the application of an iterative, gradient-based motion compensation algorithm. By optimizing the underlying motion parameters to maximize likelihood, our method effectively reduces motion artifacts, bringing the image closer to the distribution of motion-free scans. Our approach achieves comparable performance to state-of-the-art methods while eliminating the need for a representative data set of motion-affected samples. This is particularly advantageous in real-world applications, where patient motion patterns may exhibit unforeseen variability, ensuring robustness without implicit assumptions about recoverable motion types.

Siyuan Mei, Fuxin Fan, Fabian Wagner et al.

Deep learning-based medical image processing algorithms require representative data during development. In particular, surgical data might be difficult to obtain, and high-quality public datasets are limited. To overcome this limitation and augment datasets, a widely adopted solution is the generation of synthetic images. In this work, we employ conditional diffusion models to generate knee radiographs from contour and bone segmentations. Remarkably, two distinct strategies are presented by incorporating the segmentation as a condition into the sampling and training process, namely, conditional sampling and conditional training. The results demonstrate that both methods can generate realistic images while adhering to the conditioning segmentation. The conditional training method outperforms the conditional sampling method and the conventional U-Net.

Yipeng Sun, Linda-Sophie Schneider, Chengze Ye et al.

Cone-Beam Computed Tomography (CBCT) is essential in medical imaging, and the Feldkamp-Davis-Kress (FDK) algorithm is a popular choice for reconstruction due to its efficiency. However, FDK is susceptible to noise and artifacts. While recent deep learning methods offer improved image quality, they often increase computational complexity and lack the interpretability of traditional methods. In this paper, we introduce an enhanced FDK-based neural network that maintains the classical algorithm's interpretability by selectively integrating trainable elements into the cosine weighting and filtering stages. Recognizing the challenge of a large parameter space inherent in 3D CBCT data, we leverage wavelet transformations to create sparse representations of the cosine weights and filters. This strategic sparsification reduces the parameter count by $93.75\%$ without compromising performance, accelerates convergence, and importantly, maintains the inference computational cost equivalent to the classical FDK algorithm. Our method not only ensures volumetric consistency and boosts robustness to noise, but is also designed for straightforward integration into existing CT reconstruction pipelines. This presents a pragmatic enhancement that can benefit clinical applications, particularly in environments with computational limitations.