--Safe navigation of steerable and robotic catheters in the cerebral vasculature requires awareness of the catheter's shape and pose. Currently, a significant perception burden is placed on interventionalists to mentally reconstruct and predict catheter motions from biplane fluoroscopy images. Efforts to track these catheters are limited to planar segmentation or bulky sensing instrumentation, which are incompatible with microcatheters used in neurointervention. In this work, a catheter is equipped with custom radiopaque markers arranged to enable simultaneous shape and pose estimation under biplane fluoroscopy. A design measure is proposed to guide the arrangement of these markers to minimize sensitivity to marker tracking uncertainty. Endovascular neurosurgery is a rapidly growing domain which enables treatment of cerebrovascular disease with minimally-invasive approaches. Among the most common endovascular neurointerventions include aneurysm coiling and mechanical thrombectomy (MT), which has become the gold standard for treating strokes caused by large vessel occlusions (L VOs).

Fluoroscopy is critical for real-time X-ray visualization in medical imaging. However, low-dose images are compromised by noise, potentially affecting diagnostic accuracy. Noise reduction is crucial for maintaining image quality, especially given such challenges as motion artifacts and the limited availability of clean data in medical imaging. To address these issues, we propose an unsupervised training framework for dynamic context-aware denoising of fluoroscopy image sequences. First, we train the multi-scale recurrent attention U-Net (MSR2AU-Net) without requiring clean data to address the initial noise. Second, we incorporate a knowledge distillation-based uncorrelated noise suppression module and a recursive filtering-based correlated noise suppression module enhanced with motion compensation to further improve motion compensation and achieve superior denoising performance. Finally, we introduce a novel approach by combining these modules with a pixel-wise dynamic object motion cross-fusion matrix, designed to adapt to motion, and an edge-preserving loss for precise detail retention. To validate the proposed method, we conducted extensive numerical experiments on medical image datasets, including 3500 fluoroscopy images from dynamic phantoms (2,400 images for training, 1,100 for testing) and 350 clinical images from a spinal surgery patient. Moreover, we demonstrated the robustness of our approach across different imaging modalities by testing it on the publicly available 2016 Low Dose CT Grand Challenge dataset, using 4,800 images for training and 1,136 for testing. The results demonstrate that the proposed approach outperforms state-of-the-art unsupervised algorithms in both visual quality and quantitative evaluation while achieving comparable performance to well-established supervised learning methods across low-dose fluoroscopy and CT imaging.