Unsupervised Deep Learning Registration of Uterine Cervix Sequence Images

SIMPLE SUMMARY: A sequence of images can be taken after the application of acetic acid during a colposcopic examination of the uterine cervix to capture the dynamic visual variations due to the aceto-whitening reaction on the cervical epithelium. Automated analyis of these changes require spatial alignment of the apparent change in the cervix location in the image sequence due to patient movement or imaging device repositioning. We developed a new self-supervised RGB-colored deep learning-based image registration method to automatically align the images that does not require a manually-provided reference standard. We also fine-tuned a transformer-based segmentation network to evaluate the result of our registration method which achieved 12.62% higher in Dice/IoU scores in cervix boundary detection compared to the unregistered images. ABSTRACT: During a colposcopic examination of the uterine cervix for cervical cancer prevention, one or more digital images are typically acquired after the application of diluted acetic acid. An alternative approach is to acquire a sequence of images at fixed intervals during an examination before and after applying acetic acid. This approach is asserted to be more informative as it can capture dynamic pixel intensity variations on the cervical epithelium during the aceto-whitening reaction. However, the resulting time sequence images may not be spatially aligned due to the movement of the cervix with respect to the imaging device. Disease prediction using automated visual evaluation (AVE) techniques using multiple images could be adversely impacted without correction for this misalignment. The challenge is that there is no registration ground truth to help train a supervised-learning-based image registration algorithm. We present a novel unsupervised registration approach to align a sequence of digital cervix color images. The proposed deep-learning-based registration network consists of three branches and processes the red, green, and blue (RGB, respectively) channels of each input color image separately using an unsupervised strategy. Each network branch consists of a convolutional neural network (CNN) unit and a spatial transform unit. To evaluate the registration performance on a dataset that has no ground truth, we propose an evaluation strategy that is based on comparing automatic cervix segmentation masks in the registered sequence and the original sequence. The compared segmentation masks are generated by a fine-tuned transformer-based object detection model (DeTr). The segmentation model achieved Dice/IoU scores of 0.917/0.870 and 0.938/0.885, which are comparable to the performance of our previous model in two datasets. By comparing our segmentation on both original and registered time sequence images, we observed an average improvement in Dice scores of 12.62% following registration. Further, our approach achieved higher Dice and IoU scores and maintained full image integrity compared to a non-deep learning registration method on the same dataset.