Recursive Uncertainty-Gated Image Registration for Learning-based Algorithms

Conventional image registration algorithms are robust to domain shifts and achieve low errors, but they are slow and computationally expensive. Deep-learning methods are efficient at inference-time, but face challenges in out-of-domain samples. We propose Recursive Uncertainty-Gated Image Registration (RUGI), an algorithm for iteratively refining deformation fields predicted by learning-based registration models. At each iteration, the registration model predicts an incremental deformation, and a gating map modulates the update. Refinements are hence concentrated in regions that remain difficult to register. We explore two gating strategies: a learned uncertainty-based approach and an image residual error approach. We evaluate RUGI on cardiac MRI and echocardiography datasets and show consistent improvements over single-step inference. Ablation experiments demonstrate that iterative refinement alone improves registration, but informative spatial gating provides a significant additional benefit. The error-gated variant of RUGI can also be applied directly to existing pretrained models; applied to VoxelMorph, TransMorph, and CycleMorph, it yields MSE reductions of 27-37% with no modification to the original training procedure. The improvements in registration performance are reflected in decreased errors in ejection fraction estimation relative to ground truths. These results demonstrate that spatially selective iterative refinement provides an effective strategy to improve registration accuracy at inference-time.