A Robust Method for Real Time Intraoperative 2D and Preoperative 3D X-Ray Image Registration Based on an Enhanced Swin Transformer Framework

In image-guided surgery (IGS) practice, combining intraoperative 2D X-ray images with preoperative 3D X-ray images from computed tomography (CT) enables the rapid and accurate localization of lesions, which allows for a more minimally invasive and efficient surgery, and also reduces the risk of secondary injuries to nerves and vessels. Conventional optimization-based methods for 2D X-ray and 3D CT matching are limited in speed and precision due to non-convex optimization spaces and a constrained searching range. Recently, deep learning (DL) approaches have demonstrated remarkable proficiency in solving complex nonlinear 2D–3D registration. In this paper, a fast and robust DL-based registration method is proposed that takes an intraoperative 2D X-ray image as input, compares it with the preoperative 3D CT, and outputs their relative pose in x, y, z and pitch, yaw, roll. The method employs a dual-channel Swin transformer feature extractor equipped with attention mechanisms and feature pyramid to facilitate the correlation between features of the 2D X-ray and anatomical pose of CT. Tests on three different regions of interest acquired from open-source datasets show that our method can achieve high pose estimation accuracy (mean rotation and translation error of 0.142° and 0.362 mm, respectively) in a short time (0.02 s). Robustness tests indicate that our proposed method can maintain zero registration failures across varying levels of noise. This generalizable learning-based 2D (X-ray) and 3D (CT) registration algorithm owns promising applications in surgical navigation, targeted radiotherapy, and other clinical operations, with substantial potential for enhancing the accuracy and efficiency of image-guided surgery.