Decoupling Registration from Measurement: Longitudinal 3D Wound Assessment Anchored to Stable Peri-Wound Skin
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Abstract
Longitudinal three-dimensional wound assessment requires stable spatial correspondences across scans, yet the wound surface–the very region to be measured–changes continuously through contraction, granulation, and remodelling. Including it in registration risks absorbing genuine healing change into the spatial transformation, biasing longitudinal measurements. We decouple registration from measurement by anchoring alignment exclusively to the peri-wound healthy skin while excluding the wound from correspondence construction and transform fitting. A coarse-to-fine rigid-registration pipeline, enhanced by wound-edge distance-decaying weighting, selects the best transformation automatically from multiple candidates. On seven longitudinal tasks across four chronic-wound cases referenced to the first scan, the method achieved mean fitness of 0.57 ± 0.27, root-mean-square error (RMSE) of 2.44 ± 0.94 mm, and overlap ratio of 57.98 ± 22.68%. Where both conventional baselines failed completely, the method still produced usable alignments (fitness > 0.10, overlap > 15%). Spatial weighting further reduced mean RMSE to 2.15 mm, enabling unified quantification of wound area, volume, and depth. These findings indicate that a stable anatomical reference may matter more than algorithmic complexity in longitudinal lesion tracking–a decoupling principle applicable beyond wound care.
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