Technical Note: Iterative megavoltage CT (MVCT) reconstruction using block-matching 3D-transform (BM3D) regularization.

Purpose: Megavoltage CT (MVCT) images are noisier than kilovoltage CT (KVCT) due to low detector efficiency to high-energy x rays. Conventional denoising methods compromise edge resolution and low-contrast object visibility. In this work, we incorporated block-matching 3D-transform shrinkage (BM3D) transformation into MVCT iterative reconstruction as nonlocal patch-wise regularization.

Methods: The iterative reconstruction was achieved by adding to the existing least square data fidelity objective a regularization term, formulated as the L1 norm of the BM3D transformed image. A Fast Iterative Shrinkage-Thresholding Algorithm (FISTA) was adopted to accelerate CT reconstruction. The proposed method was compared against total variation (TV) regularization, BM3D postprocess method, and filtered back projection (FBP).

Results: In the Catphan phantom study, BM3D regularization better enhances low-contrast objects compared with TV regularization and BM3D postprocess method at the same noise level. The spatial resolution using BM3D regularization is 2.79 and 2.55 times higher than that using the TV regularization at 50% of the modulation transfer function (MTF) magnitude, for the fully sampled reconstruction and down-sampled reconstruction, respectively. The BM3D regularization images show better bony details and low-contrast soft tissues, on the head and neck (H&N) and prostate patient images.

Conclusions: The proposed iterative BM3D regularization CT reconstruction method takes advantage of both the BM3D denoising capability and iterative reconstruction data fidelity consistency. This novel approach is superior to TV regularized iterative reconstruction or BM3D postprocess for improving noisy MVCT image quality.