Computed tomography (CT) scans offer a detailed, three-dimensional representation of patients' internal organs. However, conventional CT reconstruction techniques necessitate acquiring hundreds or thousands of x-ray projections through a complete rotational scan of the body, making navigation or positioning during surgery infeasible. In image-guided radiation therapy, a method that reconstructs ultra-sparse X-ray projections into CT images, we can exploit the substantially reduced radiation dose and minimize equipment burden for localization and navigation. In this study, we introduce a novel Transformer architecture, termed XTransCT, devised to facilitate real-time reconstruction of CT images from two-dimensional X-ray images. We assess our approach regarding image quality and structural reliability using a dataset of fifty patients, supplied by a hospital, as well as the larger public dataset LIDC-IDRI, which encompasses thousands of patients. Additionally, we validated our algorithm's generalizability on the LNDb dataset. Our findings indicate that our algorithm surpasses other methods in image quality, structural precision, and generalizability. Moreover, in comparison to previous 3D convolution-based approaches, we note a substantial speed increase of approximately 300 %, achieving 44 ms per 3D image reconstruction.

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