Probabilistic self-learning framework for low-dose CT denoising

Purpose Despite the indispensable role of x-ray computed tomography (CT) in diagnostic medicine, the associated harmful ionizing radiation dose is a major concern, as it may cause genetic diseases and cancer. Decreasing patients' exposure can reduce the radiation dose and hence the related risks, but it would inevitably induce higher quantum noise. Supervised deep learning techniques have been used to train deep neural networks for denoising low-dose CT (LDCT) images, but the success of such strategies requires massive sets of pixel-level paired LDCT and normal-dose CT (NDCT) images, which are rarely available in real clinical practice. Our purpose is to mitigate the data scarcity problem for deep learning-based LDCT denoising. Methods To solve this problem, we devised a shift-invariant property-based neural network that uses only the LDCT images to characterize both the inherent pixel correlations and the noise distribution, shaping into our probabilistic self-learning (PSL) framework. The AAPM Low-dose CT Challenge dataset was used to train the network. Both simulated datasets and real dataset were employed to test the denoising performance as well as the model generalizability. The performance was compared to a conventional method (total variation (TV)-based), a popular self-learning method (noise2void (N2V)), and a well-known unsupervised learning method (CycleGAN) by using both qualitative visual inspection and quantitative metrics including peak signal-noise-ratio (PSNR), structural similarity index (SSIM) and contrast-to-noise-ratio (CNR). The standard deviations (STD) of selected flat regions were also calculated for comparison. Results The PSL method can improve the averaged PSNR/SSIM values from 27.61/0.5939 (LDCT) to 30.50/0.6797. By contrast, the averaged PSNR/SSIM values were 31.49/0.7284 (TV), 29.43/0.6699 (N2V), and 29.79/0.6992 (CycleGAN). The averaged STDs of selected flat regions were calculated to be 132.3 HU (LDCT), 25.77 HU (TV), 19.95 HU (N2V), 75.06 HU (CycleGAN), 60.62 HU (PSL) and 57.28 HU (NDCT). As for the low-contrast lesion detectability quantification, the CNR were calculated to be 0.202 (LDCT), 0.356 (TV), 0.372 (N2V), 0.383 (CycleGAN), 0.399 (PSL), and 0.359 (NDCT). By visual inspection, we observed that the proposed PSL method can deliver a noise-suppressed and detail-preserved image, while the TV-based method would lead to the blocky artifact, the N2V method would produce over-smoothed structures and CT value biased effect, and the CycleGAN method would generate slightly noisy results with inaccurate CT values. We also verified the generalizability of the PSL method, which exhibited superior denoising performance among various testing datasets with different data distribution shifts. Conclusions A deep learning-based convolutional neural network can be trained without paired datasets. Qualitatively visual inspection showed the proposed PSL method can achieve superior denoising performance than all the competitors, despite that the employed quantitative metrics in terms of PSNR, SSIM and CNR did not always show consistently better values.