Raúl San Jośe Estépar

Lin Tian, Hastings Greer, Raúl San José Estépar et al. · harvard

This work proposes NePhi, a generalizable neural deformation model which results in approximately diffeomorphic transformations. In contrast to the predominant voxel-based transformation fields used in learning-based registration approaches, NePhi represents deformations functionally, leading to great flexibility within the design space of memory consumption during training and inference, inference time, registration accuracy, as well as transformation regularity. Specifically, NePhi 1) requires less memory compared to voxel-based learning approaches, 2) improves inference speed by predicting latent codes, compared to current existing neural deformation based registration approaches that \emph{only} rely on optimization, 3) improves accuracy via instance optimization, and 4) shows excellent deformation regularity which is highly desirable for medical image registration. We demonstrate the performance of NePhi on a 2D synthetic dataset as well as for real 3D medical image datasets (e.g., lungs and brains). Our results show that NePhi can match the accuracy of voxel-based representations in a single-resolution registration setting. For multi-resolution registration, our method matches the accuracy of current SOTA learning-based registration approaches with instance optimization while reducing memory requirements by a factor of five. Our code is available at https://github.com/uncbiag/NePhi.

Basar Demir, Lin Tian, Thomas Hastings Greer et al. · harvard

Modern medical image registration approaches predict deformations using deep networks. These approaches achieve state-of-the-art (SOTA) registration accuracy and are generally fast. However, deep learning (DL) approaches are, in contrast to conventional non-deep-learning-based approaches, anatomy-specific. Recently, a universal deep registration approach, uniGradICON, has been proposed. However, uniGradICON focuses on monomodal image registration. In this work, we therefore develop multiGradICON as a first step towards universal *multimodal* medical image registration. Specifically, we show that 1) we can train a DL registration model that is suitable for monomodal *and* multimodal registration; 2) loss function randomization can increase multimodal registration accuracy; and 3) training a model with multimodal data helps multimodal generalization. Our code and the multiGradICON model are available at https://github.com/uncbiag/uniGradICON.

Lin Tian, Hastings Greer, François-Xavier Vialard et al. · harvard

We present an approach to learning regular spatial transformations between image pairs in the context of medical image registration. Contrary to optimization-based registration techniques and many modern learning-based methods, we do not directly penalize transformation irregularities but instead promote transformation regularity via an inverse consistency penalty. We use a neural network to predict a map between a source and a target image as well as the map when swapping the source and target images. Different from existing approaches, we compose these two resulting maps and regularize deviations of the $\bf{Jacobian}$ of this composition from the identity matrix. This regularizer -- $\texttt{GradICON}$ -- results in much better convergence when training registration models compared to promoting inverse consistency of the composition of maps directly while retaining the desirable implicit regularization effects of the latter. We achieve state-of-the-art registration performance on a variety of real-world medical image datasets using a single set of hyperparameters and a single non-dataset-specific training protocol.

Hastings Greer, Lin Tian, Francois-Xavier Vialard et al. · harvard

Inverse consistency is a desirable property for image registration. We propose a simple technique to make a neural registration network inverse consistent by construction, as a consequence of its structure, as long as it parameterizes its output transform by a Lie group. We extend this technique to multi-step neural registration by composing many such networks in a way that preserves inverse consistency. This multi-step approach also allows for inverse-consistent coarse to fine registration. We evaluate our technique on synthetic 2-D data and four 3-D medical image registration tasks and obtain excellent registration accuracy while assuring inverse consistency.

Minghui Zhang, Yangqian Wu, Hanxiao Zhang et al. · harvard

Open international challenges are becoming the de facto standard for assessing computer vision and image analysis algorithms. In recent years, new methods have extended the reach of pulmonary airway segmentation that is closer to the limit of image resolution. Since EXACT'09 pulmonary airway segmentation, limited effort has been directed to quantitative comparison of newly emerged algorithms driven by the maturity of deep learning based approaches and clinical drive for resolving finer details of distal airways for early intervention of pulmonary diseases. Thus far, public annotated datasets are extremely limited, hindering the development of data-driven methods and detailed performance evaluation of new algorithms. To provide a benchmark for the medical imaging community, we organized the Multi-site, Multi-domain Airway Tree Modeling (ATM'22), which was held as an official challenge event during the MICCAI 2022 conference. ATM'22 provides large-scale CT scans with detailed pulmonary airway annotation, including 500 CT scans (300 for training, 50 for validation, and 150 for testing). The dataset was collected from different sites and it further included a portion of noisy COVID-19 CTs with ground-glass opacity and consolidation. Twenty-three teams participated in the entire phase of the challenge and the algorithms for the top ten teams are reviewed in this paper. Quantitative and qualitative results revealed that deep learning models embedded with the topological continuity enhancement achieved superior performance in general. ATM'22 challenge holds as an open-call design, the training data and the gold standard evaluation are available upon successful registration via its homepage.

Lin Tian, Yueh Z. Lee, Raúl San José Estépar et al. · harvard

We propose LiftReg, a 2D/3D deformable registration approach. LiftReg is a deep registration framework which is trained using sets of digitally reconstructed radiographs (DRR) and computed tomography (CT) image pairs. By using simulated training data, LiftReg can use a high-quality CT-CT image similarity measure, which helps the network to learn a high-quality deformation space. To further improve registration quality and to address the inherent depth ambiguities of very limited angle acquisitions, we propose to use features extracted from the backprojected 2D images and a statistical deformation model. We test our approach on the DirLab lung registration dataset and show that it outperforms an existing learning-based pairwise registration approach.

Andrea Dunn Beltran, Daniel Rho, Aarav Mehta et al.

Bronchoscopic navigation relies on registering endoscopic video to a preoperative CT scan, but respiratory motion deforms the airway by 5-20 mm, creating CT-to-body divergence that limits localization accuracy. In practice, this is mitigated through breath-hold protocols, which attempt to match the intraoperative anatomy to a static CT, but are difficult to reproduce and disrupt clinical workflow. We propose to eliminate the need for breath-hold protocols by leveraging patient-specific respiratory modeling. Paired inhale-exhale CT scans, already acquired for planning, implicitly define the patient-specific deformation space of the breathing airway. By registering these scans, we reduce respiratory motion to a single scalar breathing phase per frame, constraining all reconstructions to anatomically observed configurations. We embed this representation within a mesh-anchored Gaussian splatting framework, where a lightweight estimator infers breathing phase directly from endoscopic RGB, enabling continuous, deformation-aware reconstruction throughout the respiratory cycle without breath-holds or external sensing. To enable quantitative evaluation, we introduce RESPIRE, a physically grounded bronchoscopy simulation pipeline with per-frame ground truth for geometry, pose, breathing phase, and deformation. Experiments on RESPIRE show that our approach achieves geometrically faithful reconstruction, over 20x faster training, and 1.22 mm target localization accuracy (within the 3mm clinically relevant tolerances) outperforming unconstrained single-CT baselines. Please check out our website for additional visuals: https://asdunnbe.github.io/RESPIRE/

Lin Tian, Hastings Greer, Roland Kwitt et al. · harvard

Conventional medical image registration approaches directly optimize over the parameters of a transformation model. These approaches have been highly successful and are used generically for registrations of different anatomical regions. Recent deep registration networks are incredibly fast and accurate but are only trained for specific tasks. Hence, they are no longer generic registration approaches. We therefore propose uniGradICON, a first step toward a foundation model for registration providing 1) great performance \emph{across} multiple datasets which is not feasible for current learning-based registration methods, 2) zero-shot capabilities for new registration tasks suitable for different acquisitions, anatomical regions, and modalities compared to the training dataset, and 3) a strong initialization for finetuning on out-of-distribution registration tasks. UniGradICON unifies the speed and accuracy benefits of learning-based registration algorithms with the generic applicability of conventional non-deep-learning approaches. We extensively trained and evaluated uniGradICON on twelve different public datasets. Our code and the uniGradICON model are available at https://github.com/uncbiag/uniGradICON.

Zhengyang Shen, Jean Feydy, Peirong Liu et al.

This work investigates the use of robust optimal transport (OT) for shape matching. Specifically, we show that recent OT solvers improve both optimization-based and deep learning methods for point cloud registration, boosting accuracy at an affordable computational cost. This manuscript starts with a practical overview of modern OT theory. We then provide solutions to the main difficulties in using this framework for shape matching. Finally, we showcase the performance of transport-enhanced registration models on a wide range of challenging tasks: rigid registration for partial shapes; scene flow estimation on the Kitti dataset; and nonparametric registration of lung vascular trees between inspiration and expiration. Our OT-based methods achieve state-of-the-art results on Kitti and for the challenging lung registration task, both in terms of accuracy and scalability. We also release PVT1010, a new public dataset of 1,010 pairs of lung vascular trees with densely sampled points. This dataset provides a challenging use case for point cloud registration algorithms with highly complex shapes and deformations. Our work demonstrates that robust OT enables fast pre-alignment and fine-tuning for a wide range of registration models, thereby providing a new key method for the computer vision toolbox. Our code and dataset are available online at: https://github.com/uncbiag/robot.

Germán González, Daniel Jimenez-Carretero, Sara Rodríguez-López et al.

Rationale: Computer aided detection (CAD) algorithms for Pulmonary Embolism (PE) algorithms have been shown to increase radiologists' sensitivity with a small increase in specificity. However, CAD for PE has not been adopted into clinical practice, likely because of the high number of false positives current CAD software produces. Objective: To generate a database of annotated computed tomography pulmonary angiographies, use it to compare the sensitivity and false positive rate of current algorithms and to develop new methods that improve such metrics. Methods: 91 Computed tomography pulmonary angiography scans were annotated by at least one radiologist by segmenting all pulmonary emboli visible on the study. 20 annotated CTPAs were open to the public in the form of a medical image analysis challenge. 20 more were kept for evaluation purposes. 51 were made available post-challenge. 8 submissions, 6 of them novel, were evaluated on the 20 evaluation CTPAs. Performance was measured as per embolus sensitivity vs. false positives per scan curve. Results: The best algorithms achieved a per-embolus sensitivity of 75% at 2 false positives per scan (fps) or of 70% at 1 fps, outperforming the state of the art. Deep learning approaches outperformed traditional machine learning ones, and their performance improved with the number of training cases. Significance: Through this work and challenge we have improved the state-of-the art of computer aided detection algorithms for pulmonary embolism. An open database and an evaluation benchmark for such algorithms have been generated, easing the development of further improvements. Implications on clinical practice will need further research.

Pietro Nardelli, James C. Ross, Raúl San José Estépar

Accurately and precisely characterizing the morphology of small pulmonary structures from Computed Tomography (CT) images, such as airways and vessels, is becoming of great importance for diagnosis of pulmonary diseases. The smaller conducting airways are the major site of increased airflow resistance in chronic obstructive pulmonary disease (COPD), while accurately sizing vessels can help identify arterial and venous changes in lung regions that may determine future disorders. However, traditional methods are often limited due to image resolution and artifacts. We propose a Convolutional Neural Regressor (CNR) that provides cross-sectional measurement of airway lumen, airway wall thickness, and vessel radius. CNR is trained with data created by a generative model of synthetic structures which is used in combination with Simulated and Unsupervised Generative Adversarial Network (SimGAN) to create simulated and refined airways and vessels with known ground-truth. For validation, we first use synthetically generated airways and vessels produced by the proposed generative model to compute the relative error and directly evaluate the accuracy of CNR in comparison with traditional methods. Then, in-vivo validation is performed by analyzing the association between the percentage of the predicted forced expiratory volume in one second (FEV1\%) and the value of the Pi10 parameter, two well-known measures of lung function and airway disease, for airways. For vessels, we assess the correlation between our estimate of the small-vessel blood volume and the lungs' diffusing capacity for carbon monoxide (DLCO). The results demonstrate that Convolutional Neural Networks (CNNs) provide a promising direction for accurately measuring vessels and airways on chest CT images with physiological correlates.