Dilated FCN for Multi-Agent 2D/3D Medical Image Registration

2D/3D image registration to align a 3D volume and 2D X-ray images is a challenging problem due to its ill-posed nature and various artifacts presented in 2D X-ray images. In this paper, we propose a multi-agent system with an auto attention mechanism for robust and efficient 2D/3D image registration. Specifically, an individual agent is trained with dilated Fully Convolutional Network (FCN) to perform registration in a Markov Decision Process (MDP) by observing a local region, and the final action is then taken based on the proposals from multiple agents and weighted by their corresponding confidence levels. The contributions of this paper are threefold. First, we formulate 2D/3D registration as a MDP with observations, actions, and rewards properly defined with respect to X-ray imaging systems. Second, to handle various artifacts in 2D X-ray images, multiple local agents are employed efficiently via FCN-based structures, and an auto attention mechanism is proposed to favor the proposals from regions with more reliable visual cues. Third, a dilated FCN-based training mechanism is proposed to significantly reduce the Degree of Freedom in the simulation of registration environment, and drastically improve training efficiency by an order of magnitude compared to standard CNN-based training method. We demonstrate that the proposed method achieves high robustness on both spine cone beam Computed Tomography data with a low signal-to-noise ratio and data from minimally invasive spine surgery where severe image artifacts and occlusions are presented due to metal screws and guide wires, outperforming other state-of-the-art methods (single agent-based and optimization-based) by a large margin.