BOSS: Bones, Organs and Skin Shape Model

Objective: A digital twin of a patient can be a valuable tool for enhancing clinical tasks such as workflow automation, patient-specific X-ray dose optimization, markerless tracking, positioning, and navigation assistance in image-guided interventions. However, it is crucial that the patient's surface and internal organs are of high quality for any pose and shape estimates. At present, the majority of statistical shape models (SSMs) are restricted to a small number of organs or bones or do not adequately represent the general population. Method: To address this, we propose a deformable human shape and pose model that combines skin, internal organs, and bones, learned from CT images. By modeling the statistical variations in a pose-normalized space using probabilistic PCA while also preserving joint kinematics, our approach offers a holistic representation of the body that can benefit various medical applications. Results: We assessed our model's performance on a registered dataset, utilizing the unified shape space, and noted an average error of 3.6 mm for bones and 8.8 mm for organs. To further verify our findings, we conducted additional tests on publicly available datasets with multi-part segmentations, which confirmed the effectiveness of our model. Conclusion: This works shows that anatomically parameterized statistical shape models can be created accurately and in a computationally efficient manner. Significance: The proposed approach enables the construction of shape models that can be directly applied to various medical applications, including biomechanics and reconstruction.

PLIKS: A Pseudo-Linear Inverse Kinematic Solver for 3D Human Body Estimation

We consider the problem of reconstructing a 3D mesh of the human body from a single 2D image as a model-in-the-loop optimization problem. Existing approaches often regress the shape, pose, and translation parameters of a parametric statistical model assuming a weak-perspective camera. In contrast, we first estimate 2D pixel-aligned vertices in image space and propose PLIKS (Pseudo-Linear Inverse Kinematic Solver) to regress the model parameters by minimizing a linear least squares problem. PLIKS is a linearized formulation of the parametric SMPL model, which provides an optimal pose and shape solution from an adequate initialization. Our method is based on analytically calculating an initial pose estimate from the network predicted 3D mesh followed by PLIKS to obtain an optimal solution for the given constraints. As our framework makes use of 2D pixel-aligned maps, it is inherently robust to partial occlusion. To demonstrate the performance of the proposed approach, we present quantitative evaluations which confirm that PLIKS achieves more accurate reconstruction with greater than 10% improvement compared to other state-of-the-art methods with respect to the standard 3D human pose and shape benchmarks while also obtaining a reconstruction error improvement of 12.9 mm on the newer AGORA dataset.

Self-Supervised 2D/3D Registration for X-Ray to CT Image Fusion

Deep Learning-based 2D/3D registration enables fast, robust, and accurate X-ray to CT image fusion when large annotated paired datasets are available for training. However, the need for paired CT volume and X-ray images with ground truth registration limits the applicability in interventional scenarios. An alternative is to use simulated X-ray projections from CT volumes, thus removing the need for paired annotated datasets. Deep Neural Networks trained exclusively on simulated X-ray projections can perform significantly worse on real X-ray images due to the domain gap. We propose a self-supervised 2D/3D registration framework combining simulated training with unsupervised feature and pixel space domain adaptation to overcome the domain gap and eliminate the need for paired annotated datasets. Our framework achieves a registration accuracy of 1.83$\pm$1.16 mm with a high success ratio of 90.1% on real X-ray images showing a 23.9% increase in success ratio compared to reference annotation-free algorithms.

Deep Iterative 2D/3D Registration

Deep Learning-based 2D/3D registration methods are highly robust but often lack the necessary registration accuracy for clinical application. A refinement step using the classical optimization-based 2D/3D registration method applied in combination with Deep Learning-based techniques can provide the required accuracy. However, it also increases the runtime. In this work, we propose a novel Deep Learning driven 2D/3D registration framework that can be used end-to-end for iterative registration tasks without relying on any further refinement step. We accomplish this by learning the update step of the 2D/3D registration framework using Point-to-Plane Correspondences. The update step is learned using iterative residual refinement-based optical flow estimation, in combination with the Point-to-Plane correspondence solver embedded as a known operator. Our proposed method achieves an average runtime of around 8s, a mean re-projection distance error of 0.60 $\pm$ 0.40 mm with a success ratio of 97 percent and a capture range of 60 mm. The combination of high registration accuracy, high robustness, and fast runtime makes our solution ideal for clinical applications.

Deep Learning compatible Differentiable X-ray Projections for Inverse Rendering

Many minimally invasive interventional procedures still rely on 2D fluoroscopic imaging. Generating a patient-specific 3D model from these X-ray projection data would allow to improve the procedural workflow, e.g. by providing assistance functions such as automatic positioning. To accomplish this, two things are required. First, a statistical human shape model of the human anatomy and second, a differentiable X-ray renderer. In this work, we propose a differentiable renderer by deriving the distance travelled by a ray inside mesh structures to generate a distance map. To demonstrate its functioning, we use it for simulating X-ray images from human shape models. Then we show its application by solving the inverse problem, namely reconstructing 3D models from real 2D fluoroscopy images of the pelvis, which is an ideal anatomical structure for patient registration. This is accomplished by an iterative optimization strategy using gradient descent. With the majority of the pelvis being in the fluoroscopic field of view, we achieve a mean Hausdorff distance of 30 mm between the reconstructed model and the ground truth segmentation.

Learning the Update Operator for 2D/3D Image Registration

Image guidance in minimally invasive interventions is usually provided using live 2D X-ray imaging. To enhance the information available during the intervention, the preoperative volume can be overlaid over the 2D images using 2D/3D image registration. Recently, deep learning-based 2D/3D registration methods have shown promising results by improving computational efficiency and robustness. However, there is still a gap in terms of registration accuracy compared to traditional optimization-based methods. We aim to address this gap by incorporating traditional methods in deep neural networks using known operator learning. As an initial step in this direction, we propose to learn the update step of an iterative 2D/3D registration framework based on the Point-to-Plane Correspondence model. We embed the Point-to-Plane Correspondence model as a known operator in our deep neural network and learn the update step for the iterative registration. We show an improvement of 1.8 times in terms of registration accuracy for the update step prediction compared to learning without the known operator.