Jean-Louis Dillenseger

François Lecomte, Jean-Louis Dillenseger, Stéphane Cotin

Purpose: The purpose of this paper is to present a method for real-time 2D-3D non-rigid registration using a single fluoroscopic image. Such a method can find applications in surgery, interventional radiology and radiotherapy. By estimating a three-dimensional displacement field from a 2D X-ray image, anatomical structures segmented in the preoperative scan can be projected onto the 2D image, thus providing a mixed reality view. Methods: A dataset composed of displacement fields and 2D projections of the anatomy is generated from the preoperative scan. From this dataset, a neural network is trained to recover the unknown 3D displacement field from a single projection image. Results: Our method is validated on lung 4D CT data at different stages of the lung deformation. The training is performed on a 3D CT using random (non domain-specific) diffeomorphic deformations, to which perturbations mimicking the pose uncertainty are added. The model achieves a mean TRE over a series of landmarks ranging from 2.3 to 5.5 mm depending on the amplitude of deformation. Conclusion: In this paper, a CNN-based method for real-time 2D-3D non-rigid registration is presented. This method is able to cope with pose estimation uncertainties, making it applicable to actual clinical scenarios, such as lung surgery, where the C-arm pose is planned before the intervention.

Valentin Boussot, Cédric Hémon, Jean-Claude Nunes et al.

In this work, we address the TrackRAD2025 challenge of real-time tumor tracking in cine-MRI sequences of the thoracic and abdominal regions under strong data scarcity constraints. Two complementary strategies were explored: (i) unsupervised registration with the IMPACT similarity metric and (ii) foundation model-based segmentation leveraging SAM 2.1 and its recent variants through prompt-based interaction. Due to the one-second runtime constraint, the SAM-based method was ultimately selected. The final configuration used SAM2.1 b+ with mask-based prompts from the first annotated slice, fine-tuned solely on the small labeled subset from TrackRAD2025. Training was configured to minimize overfitting, using 1024x1024 patches (batch size 1), standard augmentations, and a balanced Dice + IoU loss. A low uniform learning rate (0.0001) was applied to all modules (prompt encoder, decoder, Hiera backbone) to preserve generalization while adapting to annotator-specific styles. Training lasted 300 epochs (~12h on RTX A6000, 48GB). The same inference strategy was consistently applied across all anatomical sites and MRI field strengths. Test-time augmentation was considered but ultimately discarded due to negligible performance gains. The final model was selected based on the highest Dice Similarity Coefficient achieved on the validation set after fine-tuning. On the hidden test set, the model reached a Dice score of 0.8794, ranking 6th overall in the TrackRAD2025 challenge. These results highlight the strong potential of foundation models for accurate and real-time tumor tracking in MRI-guided radiotherapy.

Valentin Boussot, Jean-Louis Dillenseger

KonfAI is a modular, extensible, and fully configurable deep learning framework specifically designed for medical imaging tasks. It enables users to define complete training, inference, and evaluation workflows through structured YAML configuration files, without modifying the underlying code. This declarative approach enhances reproducibility, transparency, and experimental traceability while reducing development time. Beyond the capabilities of standard pipelines, KonfAI provides native abstractions for advanced strategies including patch-based learning, test-time augmentation, model ensembling, and direct access to intermediate feature representations for deep supervision. It also supports complex multi-model training setups such as generative adversarial architectures. Thanks to its modular and extensible architecture, KonfAI can easily accommodate custom models, loss functions, and data processing components. The framework has been successfully applied to segmentation, registration, and image synthesis tasks, and has contributed to top-ranking results in several international medical imaging challenges. KonfAI is open source and available at https://github.com/vboussot/KonfAI.

Viktor Rogowski, Maarten L. Terpstra, Niklas Wahl et al.

Radiation therapy (RT) requires precise dose delivery over multiple fractions, with CT fundamental for treatment planning due to its electron density information. Repeated CT acquisitions impose radiation exposure and logistical burdens, MRI lacks electron density, and cone-beam CT (CBCT) requires correction for dose calculation. Synthetic CT (sCT) generation addresses these by converting MRI or CBCT into CT-equivalent images with accurate Hounsfield Unit (HU) values, enabling MRI-only RT and CBCT-based adaptive workflows. Building on SynthRAD2023, SynthRAD2025 benchmarked sCT methods on 2,362 patients from five European centers across head and neck, thorax, and abdomen. Two tasks: MRI-to-CT (890 cases) and CBCT-to-CT (1,472 cases), evaluated via image similarity (MAE, PSNR, MS-SSIM), segmentation (Dice, HD95), and dosimetric metrics from photon and proton plans. With 803 participants and 12/13 valid submissions, Task 1 top performance reached MAE $64.8\pm21.3$ HU, PSNR $\sim$30 dB, MS-SSIM $\sim$0.936, Dice 0.79, photon $γ_{2\%/2\text{mm}}>98\%$, proton $γ\approx85\%$. Task 2 improved: MAE $48.3\pm13.4$ HU, PSNR 32.6 dB, MS-SSIM 0.968, Dice 0.86, photon $γ>99\%$, proton $γ\approx89\%$. Strong image--segmentation correlations ($ρ=0.78$--$0.79$) but moderate dose correlations confirmed image quality is insufficient as a dosimetric surrogate. Head-and-neck cases were most consistent; thoracic and abdominal cases showed greater variability. Residual errors at tissue interfaces propagate along beam paths, affecting proton dose more than photon. SynthRAD2025 demonstrates that deep learning yields clinically relevant sCTs, especially for CBCT-to-CT, while identifying persistent MRI-to-CT challenges and underscoring dose-based evaluation as essential for clinical validation.

Valentin Boussot, Cédric Hémon, Jean-Claude Nunes et al.

Image registration is fundamental in medical imaging, enabling precise alignment of anatomical structures for diagnosis, treatment planning, image-guided interventions, and longitudinal monitoring. This work introduces IMPACT (Image Metric with Pretrained model-Agnostic Comparison for Transmodality registration), a novel similarity metric designed for robust multimodal image registration. Rather than relying on raw intensities, handcrafted descriptors, or task-specific training, IMPACT defines a semantic similarity measure based on the comparison of deep features extracted from large-scale pretrained segmentation models. By leveraging representations from models such as TotalSegmentator, Segment Anything (SAM), and other foundation networks, IMPACT provides a task-agnostic, training-free solution that generalizes across imaging modalities. These features, originally trained for segmentation, offer strong spatial correspondence and semantic alignment capabilities, making them naturally suited for registration. The method integrates seamlessly into both algorithmic (Elastix) and learning-based (VoxelMorph) frameworks, leveraging the strengths of each. IMPACT was evaluated on five challenging 3D registration tasks involving thoracic CT/CBCT and pelvic MR/CT datasets. Quantitative metrics, including Target Registration Error and Dice Similarity Coefficient, demonstrated consistent improvements in anatomical alignment over baseline methods. Qualitative analyses further highlighted the robustness of the proposed metric in the presence of noise, artifacts, and modality variations. With its versatility, efficiency, and strong performance across diverse tasks, IMPACT offers a powerful solution for advancing multimodal image registration in both clinical and research settings.

Meritxell Riera-Marin, Sikha O K, Julia Rodriguez-Comas et al.

Deep learning (DL) has become the dominant approach for medical image segmentation, yet ensuring the reliability and clinical applicability of these models requires addressing key challenges such as annotation variability, calibration, and uncertainty estimation. This is why we created the Calibration and Uncertainty for multiRater Volume Assessment in multiorgan Segmentation (CURVAS), which highlights the critical role of multiple annotators in establishing a more comprehensive ground truth, emphasizing that segmentation is inherently subjective and that leveraging inter-annotator variability is essential for robust model evaluation. Seven teams participated in the challenge, submitting a variety of DL models evaluated using metrics such as Dice Similarity Coefficient (DSC), Expected Calibration Error (ECE), and Continuous Ranked Probability Score (CRPS). By incorporating consensus and dissensus ground truth, we assess how DL models handle uncertainty and whether their confidence estimates align with true segmentation performance. Our findings reinforce the importance of well-calibrated models, as better calibration is strongly correlated with the quality of the results. Furthermore, we demonstrate that segmentation models trained on diverse datasets and enriched with pre-trained knowledge exhibit greater robustness, particularly in cases deviating from standard anatomical structures. Notably, the best-performing models achieved high DSC and well-calibrated uncertainty estimates. This work underscores the need for multi-annotator ground truth, thorough calibration assessments, and uncertainty-aware evaluations to develop trustworthy and clinically reliable DL-based medical image segmentation models.

Valentin Boussot, Cédric Hémon, Jean-Claude Nunes et al.

We participated in the SynthRAD2025 challenge (Tasks 1 and 2) with a unified pipeline for synthetic CT (sCT) generation from MRI and CBCT, implemented using the KonfAI framework. Our model is a 2.5D U-Net++ with a ResNet-34 encoder, trained jointly across anatomical regions and fine-tuned per region. The loss function combined pixel-wise L1 loss with IMPACT-Synth, a perceptual loss derived from SAM and TotalSegmentator to enhance structural fidelity. Training was performed using AdamW (initial learning rate = 0.001, halved every 25k steps) on patch-based, normalized, body-masked inputs (320x320 for MRI, 256x256 for CBCT), with random flipping as the only augmentation. No post-processing was applied. Final predictions leveraged test-time augmentation and five-fold ensembling. The best model was selected based on validation MAE. Two registration strategies were evaluated: (i) Elastix with mutual information, consistent with the challenge pipeline, and (ii) IMPACT, a feature-based similarity metric leveraging pretrained segmentation networks. On the local test sets, IMPACT-based registration achieved more accurate and anatomically consistent alignments than mutual-information-based registration, resulting in improved sCT synthesis with lower MAE and more realistic anatomical structures. On the public validation set, however, models trained with Elastix-aligned data achieved higher scores, reflecting a registration bias favoring alignment strategies consistent with the evaluation pipeline. This highlights how registration errors can propagate into supervised learning, influencing both training and evaluation, and potentially inflating performance metrics at the expense of anatomical fidelity. By promoting anatomically consistent alignment, IMPACT helps mitigate this bias and supports the development of more robust and generalizable sCT synthesis models.

Song Wang, Yuting He, Youyong Kong et al.

Renal compartment segmentation on CT images targets on extracting the 3D structure of renal compartments from abdominal CTA images and is of great significance to the diagnosis and treatment for kidney diseases. However, due to the unclear compartment boundary, thin compartment structure and large anatomy variation of 3D kidney CT images, deep-learning based renal compartment segmentation is a challenging task. We propose a novel weakly supervised learning framework, Cycle Prototype Network, for 3D renal compartment segmentation. It has three innovations: 1) A Cycle Prototype Learning (CPL) is proposed to learn consistency for generalization. It learns from pseudo labels through the forward process and learns consistency regularization through the reverse process. The two processes make the model robust to noise and label-efficient. 2) We propose a Bayes Weakly Supervised Module (BWSM) based on cross-period prior knowledge. It learns prior knowledge from cross-period unlabeled data and perform error correction automatically, thus generates accurate pseudo labels. 3) We present a Fine Decoding Feature Extractor (FDFE) for fine-grained feature extraction. It combines global morphology information and local detail information to obtain feature maps with sharp detail, so the model will achieve fine segmentation on thin structures. Our model achieves Dice of 79.1% and 78.7% with only four labeled images, achieving a significant improvement by about 20% than typical prototype model PANet.

Yuting He, Tiantian Li, Guanyu Yang et al.

Deep learning-based medical image registration and segmentation joint models utilize the complementarity (augmentation data or weakly supervised data from registration, region constraints from segmentation) to bring mutual improvement in complex scene and few-shot situation. However, further adoption of the joint models are hindered: 1) the diversity of augmentation data is reduced limiting the further enhancement of segmentation, 2) misaligned regions in weakly supervised data disturb the training process, 3) lack of label-based region constraints in few-shot situation limits the registration performance. We propose a novel Deep Complementary Joint Model (DeepRS) for complex scene registration and few-shot segmentation. We embed a perturbation factor in the registration to increase the activity of deformation thus maintaining the augmentation data diversity. We take a pixel-wise discriminator to extract alignment confidence maps which highlight aligned regions in weakly supervised data so the misaligned regions' disturbance will be suppressed via weighting. The outputs from segmentation model are utilized to implement deep-based region constraints thus relieving the label requirements and bringing fine registration. Extensive experiments on the CT dataset of MM-WHS 2017 Challenge show great advantages of our DeepRS that outperforms the existing state-of-the-art models.

Yannick Wend Kuni Zoetgnande, Geoffroy Cormier, Alain-Jérôme Fougères et al.

In the context of a localization and tracking application, we developed a stereo vision system based on cheap low-resolution 80x60 pixels thermal cameras. We proposed a threefold sub-pixel stereo matching framework (called ST for Subpixel Thermal): 1) robust features extraction method based on phase congruency, 2) rough matching of these features in pixel precision, and 3) refined matching in sub-pixel accuracy based on local phase coherence. We performed experiments on our very low-resolution thermal images (acquired using a stereo system we manufactured) as for high-resolution images from a benchmark dataset. Even if phase congruency computation time is high, it was able to extract two times more features than state-of-the-art methods such as ORB or SURF. We proposed a modified version of the phase correlation applied in the phase congruency feature space for sub-pixel matching. Using simulated stereo, we investigated how the phase congruency threshold and the sub-image size of sub-pixel matching can influence the accuracy. We then proved that given our stereo setup and the resolution of our images, being wrong of 1 pixel leads to a 500 mm error in the Z position of the point. Finally, we showed that our method could extract four times more matches than a baseline method ORB + OpenCV KNN matching on low-resolution images. Moreover, our matches were more robust. More precisely, when projecting points of a standing person, ST got a standard deviation of 300 mm when ORB + OpenCV KNN gave more than 1000 mm.