Deep learning-based 2D/3D registration of an atlas to biplanar X-ray images

The registration of a 3D atlas image to 2D radiographs enables 3D pre-operative planning without the need to acquire costly and high-dose CT-scans. Recently, many deep-learning-based 2D/3D registration methods have been proposed which tackle the problem as a reconstruction by regressing the 3D image immediately from the radiographs, rather than registering an atlas image. Consequently, they are less constrained against unfeasible reconstructions and have no possibility to warp auxiliary data. Finally, they are, by construction, limited to orthogonal projections.We propose a novel end-to-end trainable 2D/3D registration network that regresses a dense deformation field that warps an atlas image such that the forward projection of the warped atlas matches the input 2D radiographs. We effectively take the projection matrix into account in the regression problem by integrating a projective and inverse projective spatial transform layer into the network.Comprehensive experiments conducted on simulated DRRs from patient CT images demonstrate the efficacy of the network. Our network yields an average Dice score of 0.94 and an average symmetric surface distance of 0.84 mm on our test dataset. It has experimentally been determined that projection geometries with 80[Formula: see text] to 100[Formula: see text] projection angle difference result in the highest accuracy.Our network is able to accurately reconstruct patient-specific CT-images from a pair of near-orthogonal calibrated radiographs by regressing a deformation field that warps an atlas image or any other auxiliary data. Our method is not constrained to orthogonal projections, increasing its applicability in medical practices. It remains a future task to extend the network for uncalibrated radiographs.