GeoPose: Patient-agnostic CTA-to-DSA registration through projection-space calibration

Intraoperative 2D/3D registration aligns preoperative CT volumes with intraoperative X-ray or fluoroscopic images and is essential for image-guided interventions. Recent learning-based and differentiable registration methods have shown promising accuracy, especially in patient-specific settings where abundant digitally reconstructed radiographs (DRRs) can be synthesized from the target CT. However, training a separate patient-specific model from scratch for every new patient is computationally inefficient and limits practical deployment. In this work, we propose an efficient patient-specific 2D/3D registration framework based on patient-agnostic synthetic pretraining and spherical similarity learning. The model is first pretrained on synthetic DRRs generated from multiple CT volumes to learn transferable pose-sensitive representations, and is then adapted to a new patient using only a limited number of synthetic projections from the target CT. To improve synthetic-to-real robustness without requiring anatomical labels, we introduce a segmentation-free domain randomization strategy that perturbs image intensity, projection physics, field-of-view, occlusion, and fluoroscopic artifacts. The adapted model provides an initial pose estimate, which is further refined using spherical similarity learning and differentiable Levenberg-Marquardt optimization. Experiments on multiple anatomical datasets evaluate whether patient-agnostic synthetic pretraining can improve the efficiency of patient-specific registration, with particular focus on the trade-off between adaptation cost and registration accuracy. The results demonstrate that patient-agnostic synthetic pretraining can significantly reduce patient-specific training requirements while preserving accurate intraoperative 2D/3D registration.

Accurate registration of CAD models to CT scans is essential for establishing ground truth geometry in volumetric imaging. Obtaining reliable object masks is of growing importance in machine learning settings; as recent architectures grow more capable, huge datasets are required to fully utilise their capabilities. Traditional intensity-based methods fail when CT grayscale values lack calibration references, while point-based algorithms (e.g., ICP, RANSAC) require feature correspondence unavailable between idealized CAD geometry and noisy volumetric CT data. We propose a two-stage geometric registration method for cylindrical objects (ionization chambers) that takes advantage of the distinctive geometric features of the objects. First, we estimate the 3D rotation axis by detecting elliptical cross-sections across CT slices, fitting ellipses to edge-detected contours, and performing PCA on the fitted ellipse centers after RANSAC outlier removal. Second, we voxelize the CAD model, orient it along the detected axis, and maximize volumetric overlap with the CT scan through translational adjustment. This approach achieves robust registration with tilt and orientation errors below $0.1^\circ$ without intensity calibration or feature matching. Once registered, the aligned CAD model provides ground truth geometry for applications including machine learning-based object localization and automated analysis in industrial CT workflows.

3D/2D registration serves as a cornerstone technique in surgical navigation. Traditional iterative optimization algorithms suffer from low efficiency and high failure rates in intraoperative settings. Deep learning-based methods reformulate registration from iterative optimization to a regression problem that maps image appearance features to spatial pose, typically achieving improved real-time performance and accuracy. However, such learnable methods are confined to memory-driven retrieval of specific pose features rather than understanding the task of image alignment itself, which limits their generalization in complex scenarios. We propose LayersReg, a pioneering regression paradigm that endows the model with 3D anatomical awareness and searches for the correct pose in a progressive, layer-by-layer manner. Inspired by the iterative pose-searching optimization criterion of classical registration, LayersReg searches for correlations between the moving and fixed images in feature space, capturing the trend of pixel flow and thereby converging iteratively toward the correct spatial pose transformation. We further design a coupling of node-wise regression with the progressive registration framework to enhance the model's perception of spatial pose changes. Experimental results demonstrate that under large offsets and multimodality conditions, LayersReg achieves high accuracy on both X-ray/CT registration (0.68°, 1.41 mm) and slice localization (0.73°, 1.55 mm) tasks, outperforming existing state-of-the-art methods while meeting the intraoperative demands for precision and real-time capability.