Existing medical image registration algorithms rely on either dataset specific training or local texture-based features to align images. The former cannot be reliably implemented without large modality-specific training datasets, while the latter lacks global semantics thus could be easily trapped at local minima. In this paper, we present a training-free deformable image registration method, DINO-Reg, leveraging a general purpose image encoder DINOv2 for image feature extraction. The DINOv2 encoder was trained using the ImageNet data containing natural images. We used the pretrained DINOv2 without any finetuning. Our method feeds the DINOv2 encoded features into a discrete optimizer to find the optimal deformable registration field. We conducted a series of experiments to understand the behavior and role of such a general purpose image encoder in the application of image registration. Combined with handcrafted features, our method won the first place in the recent OncoReg Challenge. To our knowledge, this is the first application of general vision foundation models in medical image registration.

In CMF surgery, the planning of bony movement to achieve a desired facial outcome is a challenging task. Current bone driven approaches focus on normalizing the bone with the expectation that the facial appearance will be corrected accordingly. However, due to the complex non-linear relationship between bony structure and facial soft-tissue, such bone-driven methods are insufficient to correct facial deformities. Despite efforts to simulate facial changes resulting from bony movement, surgical planning still relies on iterative revisions and educated guesses. To address these issues, we propose a soft-tissue driven framework that can automatically create and verify surgical plans. Our framework consists of a bony planner network that estimates the bony movements required to achieve the desired facial outcome and a facial simulator network that can simulate the possible facial changes resulting from the estimated bony movement plans. By combining these two models, we can verify and determine the final bony movement required for planning. The proposed framework was evaluated using a clinical dataset, and our experimental results demonstrate that the soft-tissue driven approach greatly improves the accuracy and efficacy of surgical planning when compared to the conventional bone-driven approach.

We establish an open framework for developing plan optimization models for knowledge-based planning (KBP) in radiotherapy. Our framework includes reference plans for 100 patients with head-and-neck cancer and high-quality dose predictions from 19 KBP models that were developed by different research groups during the OpenKBP Grand Challenge. The dose predictions were input to four optimization models to form 76 unique KBP pipelines that generated 7600 plans. The predictions and plans were compared to the reference plans via: dose score, which is the average mean absolute voxel-by-voxel difference in dose a model achieved; the deviation in dose-volume histogram (DVH) criterion; and the frequency of clinical planning criteria satisfaction. We also performed a theoretical investigation to justify our dose mimicking models. The range in rank order correlation of the dose score between predictions and their KBP pipelines was 0.50 to 0.62, which indicates that the quality of the predictions is generally positively correlated with the quality of the plans. Additionally, compared to the input predictions, the KBP-generated plans performed significantly better (P<0.05; one-sided Wilcoxon test) on 18 of 23 DVH criteria. Similarly, each optimization model generated plans that satisfied a higher percentage of criteria than the reference plans. Lastly, our theoretical investigation demonstrated that the dose mimicking models generated plans that are also optimal for a conventional planning model. This was the largest international effort to date for evaluating the combination of KBP prediction and optimization models. In the interest of reproducibility, our data and code is freely available at https://github.com/ababier/open-kbp-opt.