While optimization-based methods boast gen-eralizability across modalities and robust performance, learning-based methods promise peak performance, incorporating weak supervision and amortized optimization. However, the exact conditions for either paradigm to perform well over the other are shrouded and not explicitly outlined in the existing literature.

Deformable image registration estimates voxel-wise correspondences between images through spatial transformations, and plays a key role in medical imaging. While deep learning methods have significantly reduced runtime, efficiently handling large deformations remains a challenging task. Convolutional networks aggregate local features but lack direct modeling of voxel correspondences, promoting recent works to explore explicit feature matching. Among them, voxel-to-region matching is more efficient for direct correspondence modeling by computing local correlation features whithin neighbourhoods, while region-to-region matching incurs higher redundancy due to excessive correlation pairs across large regions. However, the inherent locality of voxel-to-region matching hinders the capture of long-range correspondences required for large deformations. To address this, we propose a Recurrent Correlation-based framework that dynamically relocates the matching region toward more promising positions. At each step, local matching is performed with low cost, and the estimated offset guides the next search region, supporting efficient convergence toward large deformations. In addition, we uses a lightweight recurrent update module with memory capacity and decouples motion-related and texture features to suppress semantic redundancy. We conduct extensive experiments on brain MRI and abdominal CT datasets under two settings: with and without affine pre-registration. Results show that our method exibits a strong accuracy-computation trade-off, surpassing or matching the state-of-the-art performance. For example, it achieves comparable performance on the non-affine OASIS dataset, while using only 9.5% of the FLOPs and running 96% faster than RDP, a representative high-performing method.

While optimization-based methods boast gen-eralizability across modalities and robust performance, learning-based methods promise peak performance, incorporating weak supervision and amortized optimization. However, the exact conditions for either paradigm to perform well over the other are shrouded and not explicitly outlined in the existing literature.

Objective: Deep learning-based deformable image registration has achieved strong accuracy, but remains sensitive to variations in input image characteristics such as artifacts, field-of-view mismatch, or modality difference. We aim to develop a general training paradigm that improves the robustness and generalizability of registration networks. Methods: We introduce surrogate supervision, which decouples the input domain from the supervision domain by applying estimated spatial transformations to surrogate images. This allows training on heterogeneous inputs while ensuring supervision is computed in domains where similarity is well defined. We evaluate the framework through three representative applications: artifact-robust brain MR registration, mask-agnostic lung CT registration, and multi-modal MR registration. Results: Across tasks, surrogate supervision demonstrated strong resilience to input variations including inhomogeneity field, inconsistent field-of-view, and modality differences, while maintaining high performance on well-curated data. Conclusions: Surrogate supervision provides a principled framework for training robust and generalizable deep learning-based registration models without increasing complexity. Significance: Surrogate supervision offers a practical pathway to more robust and generalizable medical image registration, enabling broader applicability in diverse biomedical imaging scenarios.

Prior medical image registration approaches, particularly learning-based methods, often require large amounts of training data, which constrains clinical adoption. To overcome this limitation, we propose a training-free pipeline that relies on a frozen DINOv3 encoder and test-time optimization of the deformation field in feature space. Across two representative benchmarks, the method is accurate and yields regular deformations. On Abdomen MR-CT, it attained the best mean Dice score (DSC) of 0.790 together with the lowest 95th percentile Hausdorff Distance (HD95) of 4.9+-5.0 and the lowest standard deviation of Log-Jacobian (SDLogJ) of 0.08+-0.02. On ACDC cardiac MRI, it improves mean DSC to 0.769 and reduces SDLogJ to 0.11 and HD95 to 4.8, a marked gain over the initial alignment. The results indicate that operating in a compact foundation feature space at test time offers a practical and general solution for clinical registration without additional training.

We developed a pipeline for registering pre-surgery Magnetic Resonance (MR) images and post-resection Ultrasound (US) images. Our approach leverages unpaired style transfer using 3D CycleGAN to generate synthetic T1 images, thereby enhancing registration performance. Additionally, our registration process employs both affine and local deformable transformations for a coarse-to-fine registration. The results demonstrate that our approach improves the consistency between MR and US image pairs in most cases.

Recent developments in neural networks have improved de-formable image registration (DIR) by amortizing iterative optimization, enabling fast and accurate DIR results. However, learning-based methods often face challenges with limited training data, large deformations, and tend to underperform compared to iterative approaches when label supervision is unavailable. While iterative methods can achieve higher accuracy in such scenarios, they are considerably slower than learning-based methods. To address these limitations, we propose VoxelOpt, a discrete optimization-based DIR framework that combines the strengths of learning-based and iterative methods to achieve a better balance between registration accuracy and runtime. VoxelOpt uses displacement entropy from local cost volumes to measure displacement signal strength at each voxel, which differs from earlier approaches in three key aspects. First, it introduces voxel-wise adaptive message passing, where voxels with lower entropy receives less influence from their neighbors. Second, it employs a multi-level image pyramid with 27-neighbor cost volumes at each level, avoiding exponential complexity growth. Third, it replaces hand-crafted features or contrastive learning with a pretrained founda-tional segmentation model for feature extraction. In abdominal CT registration, these changes allow VoxelOpt to outperform leading iterative in both efficiency and accuracy, while matching state-of-the-art learning-based methods trained with label supervision.

Deformable medical image registration is an essential task in computer-assisted interventions. This problem is particularly relevant to oncological treatments, where precise image alignment is necessary for tracking tumor growth, assessing treatment response, and ensuring accurate delivery of therapies. Recent AI methods can outperform traditional techniques in accuracy and speed, yet they often produce unreliable deformations that limit their clinical adoption. In this work, we address this challenge and introduce a novel implicit registration framework that can predict accurate and reliable deformations. Our insight is to reformulate image registration as a signal reconstruction problem: we learn a kernel function that can recover the dense displacement field from sparse keypoint correspondences. We integrate our method in a novel hierarchical architecture, and estimate the displacement field in a coarse-to-fine manner. Our formulation also allows for efficient refinement at test time, permitting clinicians to easily adjust registrations when needed. We validate our method on challenging intra-patient thoracic and abdominal zero-shot registration tasks, using public and internal datasets from the local University Hospital. Our method not only shows competitive accuracy to state-of-the-art approaches, but also bridges the generalization gap between implicit and explicit registration techniques. In particular, our method generates deformations that better preserve anatomical relationships and matches the performance of specialized commercial systems, underscoring its potential for clinical adoption.

Classical optimization and learning-based methods are the two reigning paradigms in deformable image registration. While optimization-based methods boast generalizability across modalities and robust performance, learning-based methods promise peak performance, incorporating weak supervision and amortized optimization. However, the exact conditions for either paradigm to perform well over the other are shrouded and not explicitly outlined in the existing literature. In this paper, we make an explicit correspondence between the mutual information of the distribution of per-pixel intensity and labels, and the performance of classical registration methods. This strong correlation hints to the fact that architectural designs in learning-based methods is unlikely to affect this correlation, and therefore, the performance of learning-based methods.

Deformable registration is a fundamental task in medical image processing, aiming to achieve precise alignment by establishing nonlinear correspondences between images. Traditional methods offer good adaptability and interpretability but are limited by computational efficiency. Although deep learning approaches have significantly improved registration speed and accuracy, they often lack flexibility and generalizability across different datasets and tasks. In recent years, foundation models have emerged as a promising direction, leveraging large and diverse datasets to learn universal features and transformation patterns for image registration, thus demonstrating strong cross-task transferability. However, these models still face challenges in generalization and robustness when encountering novel anatomical structures, varying imaging conditions, or unseen modalities. To address these limitations, this paper incorporates Sharpness-Aware Minimization (SAM) into foundation models to enhance their generalization and robustness in medical image registration. By optimizing the flatness of the loss landscape, SAM improves model stability across diverse data distributions and strengthens its ability to handle complex clinical scenarios. Experimental results show that foundation models integrated with SAM achieve significant improvements in cross-dataset registration performance, offering new insights for the advancement of medical image registration technology. Our code is available at https://github.com/Promise13/fm_sam}{https://github.com/Promise13/fm\_sam.