The efficacy of interventional treatments highly relies on an accurate identification of the target lesions and the interventional tools in the guidance images. Whereas X-ray radiography poses low doses to the patient, its weakness is in the superposition of the different image structures in a 2D image. Cone-beam computed tomography (CBCT) might look ideal providing exact 3D information, however this is at the cost of a higher radiation dose, longer imaging time, and more space requirements in

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... he operating room. Introducing some depth information with relatively low dose, and requiring less space, digital tomosynthesis (DTS) is a potential candidate for guiding interventions. However, due to the few number of projections and to the limited angle acquisition, DTS has poor depth resolution. Since high quality patient-specific prior CT scans are usually performed prior to the intervention for diagnosis or to plan the intervention, and given that such images share a fair amount of information with the intraoperative DTS images, we propose in this work a prior-based iterative reconstruction framework to improve the intraoperative DTS image quality. The framework is based on registering the prior CT image to an intermediate low-quality intraoperative DTS image, then iteratively re-reconstructing the intraoperative DTS image using the coregistered prior CT as the starting image. We acquired prior CT and intraoperative CBCT data of a liver phantom and simulated some intraoperative DTS projection images using a spherical ellipse scan geometry. Our results show a great improvement in the DTS image quality with the proposed method and prove the importance of choosing a good starting point for the iterative DTS reconstruction.