Background: Low-dose CT provides essential diagnostic information while minimizing radiation exposure through few-view reconstruction techniques. However, these techniques often introduce noise and artifacts, affecting diagnostic accuracy. Although L 0 -smoothing regularization methods partially address these issues, their fixed sparsity constraint cannot adapt to CT image complex characteristics, and they remain highly sensitive to regularization parameter selection. Objective: To propose a novel CT image denoising method named Variable Step Normalized Least Mean Square L 0 -smoothing (VSNLMS- L 0 ) that achieves an optimal balance between noise reduction and structural preservation while reducing sensitivity to regularization parameter selection. Methods: The VSNLMS- L 0 method employs an adaptive framework that dynamically responds to local image characteristics. The variable step-size strategy enables precise calibration of processing intensity across regions with varying noise levels and detail complexity, ingeniously combining filtered back projection (FBP) reconstruction results with L 0 -smoothing to create a composite desired signal. Conclusions: This approach offers an effective solution for enhancing low-dose CT image quality and improving diagnostic reliability.
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