Rigid 2D/3D registration of intraoperative digital x-ray images and preoperative CT and MR images

Abstract

This paper describes a novel approach to register 3D computed tomography (CT) or magnetic resonance (MR) images to a set of 2D X-ray images. Such a registration may be a valuable tool for intraoperative determination of the precise position and orientation of some anatomy of interest, defined in preoperative images. The registration is based solely on the information present in 2D and 3D images. It does not require fiducial markers, X-ray image segmentation, or construction of digitally reconstructed radiographs. The originality of the approach is in using normals to bone surfaces, preoperatively defined in 3D MR or CT data, and gradients of intraoperative X-ray images, which are back-projected towards the X-ray source. The registration is then concerned with finding that rigid transformation of a CT or MR volume, which provides the best match between surface normals and back projected gradients, considering their amplitudes and orientations. The method is tested on a lumbar spine phantom. Gold standard registration is obtained by fidicual markers attached to the phantom. Volumes of interest, containing single vertebrae, are registered to different pairs of X-ray images from different starting positions, chosen randomly and uniformly around the gold standard position. Target registration errors and rotation errors are in order of 0.3 mm and 0.35 degrees for the CT to X-ray registration and 1.3 mm and 1.5 degrees for MR to X-ray registration. The registration is shown to be fast and accurate.