Background and objectiveBackground subtraction of X-ray coronary angiograms (XCA) can significantly improve the diagnosis and treatment of coronary vessel diseases. The XCA background is complex and dynamic due to structures with different intensities and independent motion patterns, making XCA background subtraction challenging. MethodsThe current work proposes an online tree-structure-constrained robust PCA (OTS-RPCA) method to subtract the XCA background. A morphological closing operation is used as a pre-processing step to remove large-scale structures like the spine, chest and diaphragm. In the following, the XCA sequence is decomposed into three different subspaces: low-rank background, residual dynamic background and vascular foreground. A tree-structured norm is introduced and applied to the vascular submatrix to guarantee the vessel spatial coherency. Moreover, the residual dynamic background is separately extracted to remove noise and motion artifacts from the vascular foreground. The proposed algorithm also employs an adaptive regularization coefficient that tracks the vessel area changes in the XCA frames. ResultsThe proposed method is evaluated on two datasets of real clinical and synthetic low-contrast XCA sequences of 38 patients using the global and local contrast-to-noise ratio (CNR) and structural similarity index (SSIM) criteria. For the real XCA dataset, the average values of global CNR, local CNR and SSIM are 6.27, 3.07 and 0.97, while these values over the synthetic low-contrast dataset are obtained as 5.15, 2.69 and 0.94, respectively. The implemented quantitative and qualitative experiments verify the superiority of the proposed method over seven selected state-of-the-art methods in increasing the coronary vessel contrast and preserving the vessel structure. ConclusionsThe proposed OTS-RPCA background subtraction method accurately subtracts backgrounds from XCA images. Our method might provide the basis for reducing the contrast agent dose and the number of needed injections in coronary interventions.