XTransCT: ultra-fast volumetric CT reconstruction using two orthogonal x-ray projections for image-guided radiation therapy via a transformer network.

The aim of this study was to reconstruct volumetric computed tomography (CT) images in real-time from ultra-sparse two-dimensional x-ray projections, facilitating easier navigation and positioning during image-guided radiation therapy.Our approach leverages a voxel-sapce-searching Transformer model to overcome the limitations of conventional CT reconstruction techniques, which require extensive x-ray projections and lead to high radiation doses and equipment constraints.The proposed XTransCT algorithm demonstrated superior performance in terms of image quality, structural accuracy, and generalizability across different datasets, including a hospital set of 50 patients, the large-scale public LIDC-IDRI dataset, and the LNDb dataset for cross-validation. Notably, the algorithm achieved an approximately 300% improvement in reconstruction speed, with a rate of 44 ms per 3D image reconstruction compared to former 3D convolution-based methods.The XTransCT architecture has the potential to impact clinical practice by providing high-quality CT images faster and with substantially reduced radiation exposure for patients. The model's generalizability suggests it has the potential applicable in various healthcare settings.