X-ray imaging can be approximately modeled as the projection of an underlying volumetric attenuation field, with each measurement recording the accumulated attenuation along a corresponding ray path. Reconstructing a CT volume from only a few X-ray views is therefore severely ill-posed, as the projections collapse depth information and leave 3D locations of anatomical regions and their corresponding intensity distributions highly entangled and ambiguous. We observe that once the spatial organization of anatomical regions is established, estimating their CT intensities becomes substantially more tractable. Motivated by this, we propose LiftXR, an interleaved, geometry-guided framework that explicitly incorporates spatial layout recovery into CT reconstruction. Specifically, a layout lifter first generates a 3D anatomical layout from bi-planar X-rays, providing spatial guidance for an intensity renderer to reconstruct a CT volume. An anatomical parser then performs volumetric perception on the reconstruction, exploiting its spatially resolved boundary and intensity cues to recover a refined anatomical layout. This transition from projection-conditioned layout generation to reconstruction-conditioned anatomical perception allows the parsed layout to provide feedback for region-specific intensity calibration. Extensive experiments on two public datasets demonstrate that LiftXR consistently outperforms recent X-ray-to-CT reconstruction methods, establishing a new state of the art. Moreover, the reconstructed CT achieves superior performance in external downstream segmentation, indicating improved anatomical fidelity. Code will be released.
Yifei Wu, Yicheng Wu, Qiang Ma et al.· 0 citations
Advances in multimodal large language models (MLLMs) are extending radiological artificial intelligence (AI) beyond task-specific image analysis toward multimodal understanding and reasoning. Volumetric radiology, however, presents a fundamental representational mismatch: clinical interpretation often requires full-volume spatial context and acquisition-dependent quantitative information, whereas current MLLMs are commonly conditioned on selected two-dimensional (2D) images, compressed visual representations, or report-derived text. Reliable volumetric radiology AI therefore requires representations that preserve task-relevant three-dimensional (3D) information and systems that can access, verify, and integrate this information across clinical workflows. In this Review, we examine more than 200 publications through July 2026. We organize the literature around volumetric representation and multimodal understanding at the model level, agentic orchestration at the system level, and their links to clinical applications and evaluation. We review volumetric foundation models, language alignment and compression strategies, and agentic systems that extend MLLMs through planning, tools, memory, and workflow interaction. We distinguish settings in which selected 2D views or report-mediated reasoning may suffice from those that warrant native volumetric modeling. We also introduce a Claim-Design-Validation framework to assess whether technical, workflow, and clinical claims are matched by appropriate design and validation. Across the literature, native volumetric modeling and agentic capabilities depend on the spatial, quantitative, contextual, and workflow requirements of the intended task. Clinical credibility requires faithful volumetric representation, traceable system behavior, claim-aligned validation, and clearly defined human oversight in realistic workflows.
Zanting Ye, Shengyuan Liu, Xin Liu et al.· 0 citations