High-accuracy 3D image-based registration of endoscopic video to C-arm cone-beam CT for image-guided skull base surgery

Daniel J. Mirota, Ali Uneri, Sebastian Schäfer, Sajendra Nithiananthan, Douglas D. Reh, Gary L. Gallia, Russell H. Taylor, Gregory D. Hager, Jeffrey H. Siewerdsen

Research output: Chapter in Book/Report/Conference proceedingConference contribution

15 Scopus citations


Registration of endoscopic video to preoperative CT facilitates high-precision surgery of the head, neck, and skull-base. Conventional video-CT registration is limited by the accuracy of the tracker and does not use the underlying video or CT image data. A new image-based video registration method has been developed to overcome the limitations of conventional tracker-based registration. This method adds to a navigation system based on intraoperative C-arm cone- beam CT (CBCT) that reflects anatomical change, in turn providing high-accuracy registration of video to the surgical scene. The resulting registration enables visualization of the CBCT and planning data within the endoscopic video. The system incorporates a mobile C-arm for high-performance CBCT, integrated with an optical tracking system, video endoscopy, deformable registration of preoperative CT with intraoperative CBCT, and 3D visualization. As in the tracker-based approach, in the image-based video-CBCT registration the endoscope is localized using an optical tracking system that provides a quick initialization followed by a direct 3D image-based registration of the video to the CBCT. In this way, the system achieves video-CBCT registration that is both fast and accurate. Application in skull-base surgery demonstrates overlay of critical structures (e.g., carotid arteries and optic nerves) and surgical target volumes with sub-mm accuracy. Phantom and cadaver experiments show consistent improvement in target registration error (TRE) in video overlay over conventional tracker-based registration - e.g., 0.92 mm versus 1.82 mm for image-based and tracker-based registration, respectively. The proposed method represents a two-fold advance-first, through registration of video to up-to-date intraoperative CBCT (overcoming limitations associated with navigation with respect to preoperative CT), and second, through direct 3D image-based video-CBCT registration, which together provide more confident visualization of target and normal tissues within up-to-date images and improved targeting precision.

Original languageEnglish (US)
Title of host publicationMedical Imaging 2011
Subtitle of host publicationVisualization, Image-Guided Procedures, and Modeling
StatePublished - 2011
EventMedical Imaging 2011: Visualization, Image-Guided Procedures, and Modeling - Lake Buena Vista, FL, United States
Duration: Feb 13 2011Feb 15 2011

Publication series

NameProgress in Biomedical Optics and Imaging - Proceedings of SPIE
ISSN (Print)1605-7422


OtherMedical Imaging 2011: Visualization, Image-Guided Procedures, and Modeling
Country/TerritoryUnited States
CityLake Buena Vista, FL


  • 3D visualization
  • Cone-beam CT
  • Image registration
  • Image-guided surgery
  • Intra-operative imaging
  • Skull-base surgery
  • Surgical navigation
  • Video endoscopy
  • Video fusion

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Biomaterials
  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging


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