{
  "abstract": "Multi-phase contrast-enhanced computed tomography (CT) is the gold standard for renal cell carcinoma (RCC) characterization, yet clinical interpretation relies on subjective visual comparison across phases. We present PRISM (Phase-Resolved Isotropic Subtraction Mapping), an open-source automated pipeline that transforms multi-phase CT acquisitions into registered digital subtraction angiography (DSA) volumes with color-coded enhancement maps. PRISM integrates six sequential processing stages: (1) DICOM loading with automated contrast-phase classification, (2) deep learning-based isotropic interpolation via RIFE, (3) automated kidney segmentation using TotalSegmentator v2, (4) enhancement-based tissue detection, (5) three-step deformable registration (rigid, affine, B-spline) using SimpleITK, and (6) dual-channel digital subtraction visualization. We present a systematic parameter optimization study comprising 200 registrations that runs across five patients and five experiments. Key findings: We identify an efficient registration configuration combining a 40 mm B-spline grid (within 6% of the 30 mm quality optimum at 36% lower computational cost), 5% metric sampling (equivalent quality to 25% at 3.2x speedup), and a single-level multi-resolution pyramid (avoiding the 5.4x overhead of a 4,2 pyramid with no quality benefit); we show that registration quality is effectively independent of interpolation target spacing from 0.5-3.0 mm, enabling a coarse-register/fine-apply strategy that computes the full transform at 3.0 mm (approximately 4 minutes per phase) and applies it to 0.5 mm volumes for high-resolution visualization. We also determine that a 40 HU subtraction noise threshold optimally balances signal-to-noise ratio (2.00) against sensitivity (14.2% enhancing volume retained), with higher thresholds (60-80 HU) favoring specificity and lower thresholds (20 HU) favoring sensitivity.",
  "abstract_shown": true,
  "affiliations": [
    "Texas State University"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "name": "R. Rodriguez"
    },
    {
      "name": "R. Ramirez"
    },
    {
      "affs": [
        0
      ],
      "name": "H. Rathore"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bts17dfk4g8rb.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.10.26362169",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.10.26362169v1.full",
  "id": "bts17dfk4g8rb",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.10.26362169v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "radiology and imaging"
    ],
    [
      "openalex",
      "1707|Medical Image Segmentation Techniques"
    ]
  ],
  "openalex": "W7212425279",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.10.26362169v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-10",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bts17dfk4g8rb.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:28Z",
      "native_id": "10.64898/2026.09.10.26362169",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.10.26362169v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:radiology and imaging",
      "subfield": "imaging"
    }
  ],
  "title": "PRISM: Phase-Resolved Isotropic Subtraction Mapping for Automated Multi-Phase CT Digital Subtraction Angiography",
  "title_text": "PRISM: Phase-Resolved Isotropic Subtraction Mapping for Automated Multi-Phase CT Digital Subtraction Angiography",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:28Z",
  "url": "https://research.draconitic.com/paper/bts17dfk4g8rb",
  "venue": "medRxiv",
  "versions": []
}