Registration of 3D freehand ultrasound to a bone model for orthopedic procedures of the forearm

  • Matija Ciganovic
  • Firat Ozdemir
  • Fabien Pean
  • Philipp Fuernstahl
  • Christine Tanner
  • Orcun Goksel
Original Article



For guidance of orthopedic surgery, the registration of preoperative images and corresponding surgical plans with the surgical setting can be of great value. Ultrasound (US) is an ideal modality for surgical guidance, as it is non-ionizing, real time, easy to use, and requires minimal (magnetic/radiation) safety limitations. By extracting bone surfaces from 3D freehand US and registering these to preoperative bone models, complementary information from these modalities can be fused and presented in the surgical realm.


A partial bone surface is extracted from US using phase symmetry and a factor graph-based approach. This is registered to the detailed 3D bone model, conventionally generated for preoperative planning, based on a proposed multi-initialization and surface-based scheme robust to partial surfaces.


36 forearm US volumes acquired using a tracked US probe were independently registered to a 3D model of the radius, manually extracted from MRI. Given intraoperative time restrictions, a computationally efficient algorithm was determined based on a comparison of different approaches. For all 36 registrations, a mean (± SD) point-to-point surface distance of \(0.57\,(\pm \,0.08)\,\hbox {mm}\) was obtained from manual gold standard US bone annotations (not used during the registration) to the 3D bone model.


A registration framework based on the bone surface extraction from 3D freehand US and a subsequent fast, automatic surface alignment robust to single-sided view and large false-positive rates from US was shown to achieve registration accuracy feasible for practical orthopedic scenarios and a qualitative outcome indicating good visual image alignment.


Tracked ultrasound Bone segmentation Iterative refinement 



This work was funded by the Swiss National Science Foundation (SNSF) and a Highly Specialized Medicine (HSM2) grant of the Canton of Zurich.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the provincial ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2018

Authors and Affiliations

  1. 1.Computer-Assisted Applications in Medicine (CAiM)ETH ZurichZurichSwitzerland
  2. 2.Computer Assisted Research and Development (CARD), Balgrist University HospitalUniversity of ZurichZurichSwitzerland

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