AbstractBackgroundRadiation dose reduction has been the focus of many research activities in x‐ray CT. Various approaches were taken to minimize the dose to patients, ranging from the optimization of clinical protocols, refinement of the scanner hardware design, and development of advanced reconstruction algorithms. Although significant progress has been made, more advancements in this area are needed to minimize the radiation risks to patients.PurposeReconstruction algorithm‐based dose reduction approaches focus mainly on the suppression of noise in the reconstructed images while preserving detailed anatomical structures. Such an approach effectively produces synthesized high‐dose images (SHD) from the data acquired with low‐dose scans. A representative example is the model‐based iterative reconstruction (MBIR). Despite its widespread deployment, its full adoption in a clinical environment is often limited by an undesirable image texture. Recent studies have shown that deep learning image reconstruction (DLIR) can overcome this shortcoming. However, the limited availability of high‐quality clinical images for training and validation is often the bottleneck for its development. In this paper, we propose a novel approach to generate SHD with existing low‐dose clinical datasets that overcomes both the noise texture issue and the data availability issue.MethodsOur approach is based on the observation that noise in the image can be effectively reduced by performing image processing orthogonal to the imaging plane. This process essentially creates an equivalent thick‐slice image (TSI), and the characteristics of TSI depend on the nature of the image processing. An advantage of this approach is its potential to reduce impact on the noise texture. The resulting image, however, is likely corrupted by the anatomical structural degradation due to partial volume effects. Careful examination has shown that the differential signal between the original and the processed image contains sufficient information to identify regions where anatomical structures are modified. The differential signal, unfortunately, contains significant noise and has to be removed. The noise removal can be accomplished by performing iterative noise reduction to preserve structural information. The processed differential signal is subsequently subtracted from TSI to arrive at SHD.ResultsThe algorithm was evaluated extensively with phantom and clinical datasets. For better visual inspection, difference images between the original and SHD were generated and carefully examined. Negligible residual structure could be observed. In addition to the qualitative inspection, quantitative analyses were performed on clinical images in terms of the CT number consistency and the noise reduction characteristics. Results indicate that no CT number bias is introduced by the proposed algorithm. In addition, noise reduction capability is consistent across different patient anatomical regions. Further, simulated water phantom scans were utilized in the generation of the noise power spectrum (NPS) to demonstrate the preservation of the noise‐texture.ConclusionsWe present a method to generate SHD datasets from regularly acquired low‐dose CT scans. Images produced with the proposed approach exhibit excellent noise‐reduction with the desired noise‐texture. Extensive clinical and phantom studies have demonstrated the efficacy and robustness of our approach. Potential limitations of the current implementation are discussed and further research topics are outlined.