Deformable CT-US Registration via Anatomy-Aware Implicit Neural Representations

Ultrasound (US) is widely used for surgical navigation, yet real-time registration between intraoperative 2D slices and preoperative 3D volumes remains challenging due to partial observability, speckle noise, and the action-dependent US acquisition. Existing methods are one-shot or short-horizon, making it hard for them to gather evidence over time or capture how surgeons adjust probe motion based on on-screen feedback. We propose DreamReg, a belief-driven world-model framework that formulates 2D-3D registration as belief updating over rigid transformations. DreamReg maintains a latent belief state that summarizes past observations and poses information, and continuously refines the transformation through learned dynamics as new slices arrive. During training, DreamReg is exposed to probe-motion trajectories that mimic clinical scanning behavior and learns to update its belief by conditioning pose refinement on the current US observation. During inference, DreamReg refines registration via internal imagination: it rolls out the learned world model to simulate candidate probe motions and their predicted observations, and integrates these imagined outcomes to converge to an accurate rigid transformation. Experiments on CAMUS and u-RegPro datasets demonstrate improved robustness and competitive registration accuracy for real-time guidance compared with state-of-the-art methods.

Non-rigid point cloud registration is central to soft-tissue shape analysis, but large deformations, noise, and outliers make correspondence estimation challenging. Most learning-based methods rely on local objectives such as Chamfer distance, which encourage point-wise proximity but do not constrain the global plausibility of the predicted deformation field. We address this limitation with DINE, a maximum a posteriori framework that augments distance-based registration with a learned statistical prior over displacement vector fields. DINE is applied to two registration backbones, Robust-DefReg and DefTransNet, using a two-stage strategy: a first-stage model is trained with Chamfer distance, its predicted deformation fields are used to estimate a prior, and the model is then refined with a combined distance and negative log-prior objective. We compare a full-field PCA Gaussian prior with a per-vector normalizing-flow prior. Experiments on DeformedTissue and SynBench show lower mean Chamfer distance under deformation and corruption. On DeformedTissue, DINE-PCA reduces Chamfer distance by approximately 27--69% relative to the corresponding Stage-1 backbone across deformation levels, and improves robustness by up to 66% for outliers and 83% for Gaussian noise. On SynBench, improvements are modest at the smallest deformation levels and reach approximately 59--79% from moderate to severe deformation. These results suggest that global deformation plausibility is an important constraint for reliable soft-tissue point cloud registration. (The code will be published soon.)

With 890,000 annual new cases globally, head and neck squamous cell carcinoma has one of the highest recurrence rates among solid malignancies. Although frozen section analysis is the standard of care for intraoperative margin assessment, accurately relocating detected positive margins on the resection bed remains challenging due to imprecise alignment between resected specimens and their resection bed, compounded by post-resection mucosal tissue shrinkage. We present a biomechanics-driven deformable registration framework that corrects post-resection tissue deformation to provide intraoperative guidance. Our approach registers 3D specimen meshes to intraoperative resection bed point clouds using a deformable registration approach based on regularized Kelvinlet basis functions. The registration matches surface point clouds, fiducial landmarks, and boundary contour constraints that directly penalize perpendicular distance-to-agreement between specimen and resection bed boundaries. Across nine specimens from skin, buccal mucosa, and tongue sites, the overall mean target registration error was $11.11 \pm 4.07$ mm using rigid registration, which decreased to $8.20 \pm 2.68$ mm (26.19% reduction) using deformable registration without contour constraint. The proposed contour-constrained deformable registration further reduced the error to $5.62 \pm 2.28$ mm, a 49.41% reduction relative to rigid registration. We observed the largest reduction in the most clinically challenging tongue specimens. We also performed a systematic two-stage parameter search to characterize the relative importance of surface alignment, fiducial correspondences, contour constraint, and strain energy regularization. This search revealed that contour weighting dominates registration accuracy for tissue types with large lateral deformation, while the algorithm operates over a broad range of parameter combinations.