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Particularly, for the case with the largest initial landmark displacement of 15 ± 9 mm, the modified Demons algorithm had a registration error of 1.3 ± 1.1 mm, while the original Demons algorithm had a registration error of 3.6 ± 5.9 mm. We also qualitatively evaluated the modified Demons algorithm using two difficult cases in our routine clinic one lung case with large sliding motion and one head and neck case with large anatomical changes in air cavity. Visual evaluation on the deformed image created by the deformable image registration