Rapid patient-specific neural networks for intraoperative X-ray to volume registration

Advanced navigation techniques in image-guided interventions and surgical robotics require the rapid and precise alignment of 3D preoperative volumes (e.g., CT, MRI) to 2D intraoperative images (e.g., X-ray fluoroscopy). However, existing 2D/3D registration methods fail to generalize across the broad spectrum of fluoroscopy-guided procedures: traditional intensity-based optimizers require careful hyperparameter tuning for each subject, while deep learning approaches demand extensive manually labeled datasets and remain constrained to the specific anatomy on which they were trained. To address these limitations, we present xvr, a self-supervised framework that combines patient-specific neural networks with gradient-based optimization for automatic 2D/3D registration. xvr leverages physics-based simulation to generate training data from a patient's own preoperative scan, eliminating the need for manual annotation. We present a foundation model pretrained on thousands of whole-body scans, achieving patient-specific adaptation for any anatomical region in only 5 minutes of finetuning. In the largest evaluation of 2D/3D registration on real fluoroscopy to date, xvr achieves high accuracy in seconds across diverse anatomical structures, imaging modalities, and hospitals, improving upon the accuracy of existing methods by an order of magnitude. xvr makes pan-anatomical 2D/3D rigid registration accessible to broad clinical and research communities through open-source software at https://xvr.csail.mit.edu.