Towards accurate, robust and practical ultrasound-CT registration of vertebrae for image-guided spine surgery

  • Charles X. B. YanEmail author
  • Benoît Goulet
  • Julie Pelletier
  • Sean Jy-Shyang Chen
  • Donatella Tampieri
  • D. Louis Collins
Original Article



Accurate registration of patient anatomy and preoperative computed tomography (CT) images is key to successful image-guided spine surgery. Current manual landmark and surface-based techniques are time-consuming and not always accurate. Intraoperative ultrasound imaging of the vertebrae, combined with automated registration, could improve surgery by improving accuracy, reducing operative time, and decreasing invasiveness.


We present a simple ultrasound-CT registration technique that is automated, accurate, and robust. Registration is achieved by aligning the posterior vertebral surface, extracted from both CT and ultrasound images, using a forward and a backward scan line tracing method, respectively. The registration technique is validated using a simple plastic phantom in a water bath and a more realistic porcine cadaver in a simulation of open back surgery.


Clinically relevant accuracy was estimated by comparing automated registrations with gold standard imaging fiducial-based reference transformations, which yielded target registration errors of under 1 mm for the plastic phantom and under 1.6 mm for the porcine cadaver.


Our registration technique demonstrates good accuracy and robustness under clinically realistic conditions and thus warrants further studies on its surgical application.


Image-guided surgery Spine surgery Multimodal registration Ultrasound CT 


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  1. 1.
    Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery-the case for restraint. N Engl J Med 350(7): 722–726PubMedCrossRefGoogle Scholar
  2. 2.
    Castro WHM, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S (1996) Accuracy of pedicle screw placement in lumbar vertebrae. Spine 21(11): 1320–1324PubMedCrossRefGoogle Scholar
  3. 3.
    Schulze CJ, Munzinger E, Weber U (1998) Clinical relevance of accuracy of pedicle screw placement: a computed tomographic-supported analysis. Spine 23(20): 2215–2220PubMedCrossRefGoogle Scholar
  4. 4.
    Haberland N, Ebmeier K, Grunewald JP, Hliscs R, Kalff RL (2000) Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique. Comput Aided Surg 5(1): 18–27PubMedCrossRefGoogle Scholar
  5. 5.
    Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D (2000) Accuracy of pedicle screw insertion with and without computer assistance: A randomised controlled clinical study in 100 consecutive patients. Eur Spine J 9(3): 235–240PubMedCrossRefGoogle Scholar
  6. 6.
    Holly LT, Foley KT (2007) Image guidance in spine surgery. Orthop Clin N Am 38: 451–461CrossRefGoogle Scholar
  7. 7.
    Kalfas IH, Kormos DW, Murphy MA, Mckenzie RL, Barnett GH, Bell GR, Steiner CP, Trimble MB, Weisenberger JP (1995) Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 83(4): 641–647PubMedCrossRefGoogle Scholar
  8. 8.
    Glossop ND, Hu RW, Randle JA (1996) Computer-aided pedicle screw placement using frameless stereotaxis. Spine 21(17): 2026–2034PubMedCrossRefGoogle Scholar
  9. 9.
    Foley KT, Smith MM (1997) Frameless stereotactic guidance of C1-2 transarticular screw placement: clinical experience. Clin Neurol Neurosur 99(2): 360AGoogle Scholar
  10. 10.
    Bloch O, Holly LT, Park J, Obasi C, Kim K, Johnson JP (2001) Effect of frameless stereotaxy on the accuracy of C1-2 transarticular screw placement. J Neurosurg 95(1 Suppl): 74–79PubMedGoogle Scholar
  11. 11.
    Kim KD, Johnson JP, Block O, Masciopinto JE (2001) Computer-assisted thoracic pedicle screw placement: an in vitro feasibility study. Spine 26(4): 360–364PubMedCrossRefGoogle Scholar
  12. 12.
    Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48(4): 771–779PubMedGoogle Scholar
  13. 13.
    Bolger C, Wigfield C, Melkent T, Smith K (1999) Frameless stereotaxy and anterior cervical surgery. Comput Aided Surg 4(6): 322–327PubMedCrossRefGoogle Scholar
  14. 14.
    Kalfas IH (2009) Image-guided spinal navigation: Principles and clinical applications. In: Ozgur B, Benzel E, Garfin S (eds) Minimally invasive spine surgery. Springer, New York, pp 7–22CrossRefGoogle Scholar
  15. 15.
    Goulet B (2007) Lumbar pedicle screw insertion with preoperative CT-based navigation. Master’s thesis, Université de MontréalGoogle Scholar
  16. 16.
    Peters TM (2006) Image-guidance for surgical procedures. Phys Med Biol 51: R505–R540PubMedCrossRefGoogle Scholar
  17. 17.
    Holly LT, Foley KT (2003) Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note. J Neurosurg 99(3 Suppl): 324–329Google Scholar
  18. 18.
    Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2005) Utility of computerized isocentric fluoroscopy for minimally invasive spinal surgical techniques. J Spinal Disord Tech 18(4): 369–375PubMedCrossRefGoogle Scholar
  19. 19.
    Gering DT, Nabavi A, Kikinis R, Hata N, O’Donnell LJ, Grimson WEL, Jolesz FA, Black PM, WMWIII (2001) An integrated visualization system for surgical planning and guidance using image fusion and an open MR. J Magn Reson Imaging 13(6):967–975Google Scholar
  20. 20.
    Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25(20): 2637–2645PubMedCrossRefGoogle Scholar
  21. 21.
    Ault T, Siegel MW (1994) Frameless patient registration using ultrasonic imaging. In: Proceedings first international symposium on medical robotics and computer-assisted surgery, pp 74–82Google Scholar
  22. 22.
    Penney GP, Barratt DC, Chan CSK, Slomczykowski M, Carter TJ, Edwards PJ, Hawkes DJ (2005) Cadaver validation of intensity-based ultrasound to CT registration. In: Duncan J, Gerig G (eds) MICCAI 2005, vol LNCS 3750. Springer, pp 1000–1007Google Scholar
  23. 23.
    Barratt DC, Penney GP, Chan CSK, Slomczykowski M, Carter TJ, Edwards PJ, Hawkes DJ (2006) Self-calibrating 3D-ultrasound-based bone registration for minimally invasive orthopedic surgery. IEEE Trans Med Imaging 25(3): 312–323PubMedCrossRefGoogle Scholar
  24. 24.
    Barratt DC, Chan CS, Edwards PJ, Penney GP, Slomczykowski M, Carter TJ, Hawkes DJ (2008) Instantiation and registration of statistical shape models of the femur and pelvis using 3D ultrasound imaging. Med Image Anal 12(3): 358–374PubMedCrossRefGoogle Scholar
  25. 25.
    Mozes A, Chang TC, Arata L, Zhao W (2010) Three-dimensional A-mode ultrasound calibration and registration for robotic orthopaedic knee surgery. Int J Med Robot 6(1): 91–101PubMedGoogle Scholar
  26. 26.
    Tonetti J, Carrat L, Kvallek S, Pittet L, Merloz P, Chirossel JP (1998) Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop Relat Res 354: 103–110PubMedCrossRefGoogle Scholar
  27. 27.
    Ionescu G, Lavallée S, Demongeot J (1999) Automated registration of ultrasound with CT images: application to computer assisted prostate radiotherapy and orthopedics. In: Taylor C, Colchester A (eds) MICCAI 1999, vol LNCS 1679. Springer, pp 768–778Google Scholar
  28. 28.
    Carrat L, Tonetti J, Merloz P, Troccaza J (2000) Percutaneous computer assisted iliosacral screwing: clinical validation. In: Delp SL, DiGioia A, Jaramaz B (eds) MICCAI 2000, vol LNCS 1935. Springer, pp 1229–1237Google Scholar
  29. 29.
    Amin DV, Kanade T, AM DiGioia BJ III (2003) Ultrasound registration of the bone surface for surgical navigation. Comput Aided Surg 8: 1–16PubMedCrossRefGoogle Scholar
  30. 30.
    Penney GP, Barratt DC, Chan CSK, Slomczykowski M, Carter TJ, Edwards PJ, Hawkes DJ (2006) Cadaver validation of intensity-based ultrasound to CT registration. Med Image Anal 10(3): 385–395PubMedCrossRefGoogle Scholar
  31. 31.
    Moghari MH, Abolmaesumi P (2007) Point-based rigid-body registration using an unscented kalman filter. IEEE Trans Med Imaging 26(12): 1708–1728PubMedCrossRefGoogle Scholar
  32. 32.
    Foroughi P, Song D, Chintalapani G, Taylor RH, Fichtinger G (2008) Localization of pelvic anatomical coordinate system using US/atlas registration for total hip replacement. In: Metaxas D, Davies B, Axel L (eds) MICCAI 2008, vol LNCS 5242. Springer, pp 871–879Google Scholar
  33. 33.
    Oszwald M, Citak M, Kendoff D, Kowal J, Amstutz C, Kirchhoff T, Nolte L, Krettek C, Hüfner T (2008) Accuracy of navigated surgery of the pelvis after surface matching with an A-mode ultrasound probe. J Orthop Res 26(6): 860–864PubMedCrossRefGoogle Scholar
  34. 34.
    Ghanavati S, Mousavi P, Fichtinger G, Foroughi P, Abolmaesumi P (2010) Multi-slice to volume registration of ultrasound data to a statistical atlas of human pelvis. In: Miga MI, Wong KH (eds) Proceedings of SPIE, SPIE, vol 7625. pp 76250OGoogle Scholar
  35. 35.
    Lavallée S, Troccaz J, Sautot P, Mazier B, Cinquin P, Merloz P, Chirossel JP (1996) Computer-assisted spinal surgery using anatomy-based registration. In: Taylor RH, Lavallée S, Burdea GC, Mösges R (eds) Computer integrated surgery: technology and clinical applications. MIT Press, MA, pp 425–449Google Scholar
  36. 36.
    Herring JL, Dawant BM, Maurer CR Jr, Muratore DM, Galloway RL, Fitzpatrick JM (1998) Surface-based registration of CT images to physical space for image-guided surgery of the spine: a sensitivity study. IEEE Trans Med Imaging 17(5): 743–752PubMedCrossRefGoogle Scholar
  37. 37.
    Brendel B, Winter S, Rick A, Stockheim M, Ermert H (2002) Registration of 3D CT and ultrasound datasets of the spine using bone structures. Comput Aided Surg 7: 146–155PubMedCrossRefGoogle Scholar
  38. 38.
    Muratore DM, Russ JH, Dawant BM, Galloway RL Jr (2002) Three-dimensional image registration of phantom vertebrae for image-guided surgery: a preliminary study. Comput Aided Surg 7: 342–352PubMedCrossRefGoogle Scholar
  39. 39.
    Brendel B, Siepermanna J, Winter S, Ermert H (2005) In vivo evaluation and in vitro accuracy measurements for an ultrasound-CT registration algorithm. In: International congress series—CARS 2005, vol 1281. pp 583–588Google Scholar
  40. 40.
    Peterhans M, Talib H, Linguraru MG, Styner M, Ballester MAG (2008) A method for frame-by-frame US to CT registration in a joint calibration and registration framework. In: IEEE ISBI 2008, pp 1131–1134Google Scholar
  41. 41.
    Winter S, Brendel B, Pechlivanis I, Schmieder K, Igel C (2008) Registration of CT and intraoperative 3-D ultrasound images of the spine using evolutionary and gradient-based methods. IEEE Trans Evolut Comput 12(3): 284–296CrossRefGoogle Scholar
  42. 42.
    Gill S, Mousavi P, Fichtinger G, Chen E, Boisvert J, Pichora D, Abolmaesumi P (2009) Biomechanically constrained groupwise US to CT registration of the lumbar spine. In: Yang GZ, Hawkes D, Rueckert D (eds) MICCAI 2009, vol LNCS 5761. Springer, pp 803–810Google Scholar
  43. 43.
    Winter S, Pechlivanis I, Dekomien C, Igel C, Schmieder K (2009) Toward registration of 3D ultrasound and CT images of the spine in clinical praxis: Design and evaluation of a data acquisition protocol. Ultrasound Med Biol 35(11): 1773–1782PubMedCrossRefGoogle Scholar
  44. 44.
    Rasoulian A, Mousavi P, Moghari MH, Foroughi P, Abolmaesumi P (2010) Group-wise feature-based registration of CT and ultrasound images of spine. In: Miga MI, Wong KH (eds) Proceedings of SPIE, SPIE, vol 7625. pp 76250RGoogle Scholar
  45. 45.
    Gill S (2009) Biomechanically constrained ultrasound to computed tomography registration of the lumbar spine. Master’s thesis, Queen’s University.
  46. 46.
    Gill S, Abolmaesumi P, Fichtinger G, Boisvert J, Pichora D, Borshneck D, Mousavi P (2010) Biomechanically constrained groupwise ultrasound to CT registration of the lumbar spine. Med Image Anal In Press, Accepted. Manuscript: doi: 10.1016/
  47. 47.
    Glossop N, Hu R (1997) Assessment of vertebral body motion during spine surgery. Spine 22(8): 903–909PubMedCrossRefGoogle Scholar
  48. 48.
    Foroughi P, Boctor E, Swartz M, Taylor R, Fichtinger G (2007) Ultrasound bone segmentation using dynamic programming. In: Ultrasonics Symposium, 2007. IEEE, pp 2523–2526Google Scholar
  49. 49.
    Hellier P, Coupé P, Morandi X, Collins DL (2010) An automatic geometrical and statistical method to detect acoustic shadows in intraoperative ultrasound brain images. Med Image Anal 14(2): 195–204PubMedCrossRefGoogle Scholar
  50. 50.
    Jain AK, Taylor RH (2004) Understanding bone responses in B-mode ultrasound images and automatic bone surface extraction using a bayesian probabilistic framework. In: Walker WF, Emelianov SY (eds) Proceedings of SPIE: Medical Imaging 2004: Ultrasonic Imaging and Signal Processing, SPIE, vol 5373. pp 131–142Google Scholar
  51. 51.
    Nelder JA, Mead R (1965) A simplex method for function minimization. Comput J 7(4): 308–313Google Scholar
  52. 52.
    Press WH, Flannery BP, Teukolsky SA, Vetterling WT (1988) Numerical recipes in C. Cambridge University Press, CambridgeGoogle Scholar
  53. 53.
    Olsson DM, Nelson LS (1975) The nelder-mead simplex procedure for function minimization. Technometrics 17(1): 45–51CrossRefGoogle Scholar
  54. 54.
    Comeau RM, Sadikot AF, Fenster A, Peters TM (2000) Intraoperative ultrasound for guidance and tissue shift correction in image-guided neurosurgery. Med Phys 27(4): 787–800PubMedCrossRefGoogle Scholar
  55. 55.
    Dath R, Ebinesan AD, Porter KM, Miles AW (2007) Anatomical measurements of porcine lumbar vertebrae. Clin Biomech 22(5): 607–613CrossRefGoogle Scholar
  56. 56.
    Horn BK (1987) Closed-form solution of absolute orientation using unit quaternions. J Opt Soc Am A 4(4): 629–642CrossRefGoogle Scholar
  57. 57.
    Solberg OV, Lindseth F, Torp H, Blake RE, Hernes TAN (2007) Freehand 3D ultrasound reconstruction algorithms–a review. Ultrasound Med Biol 33(7): 991–1009PubMedCrossRefGoogle Scholar
  58. 58.
    Cleary K, Anderson J, Brazaitis M, Devey G, DiGioia A, Freedman M, Grönemeyer D, Lathan C, Lemke H, Long D, Mun SK, Taylor R (2000) Final report of the technical requirements for image-guided spine procedures workshop. Comput Aided Surg 5(3): 180–215PubMedGoogle Scholar

Copyright information

© CARS 2010

Authors and Affiliations

  • Charles X. B. Yan
    • 1
    Email author
  • Benoît Goulet
    • 2
  • Julie Pelletier
    • 1
  • Sean Jy-Shyang Chen
    • 1
  • Donatella Tampieri
    • 3
  • D. Louis Collins
    • 1
  1. 1.McConnell Brain Imaging CentreMontreal Neurological InstituteMontrealCanada
  2. 2.Department of Neurology and NeurosurgeryMcGill UniversityMontrealCanada
  3. 3.Diagnostic and Interventional NeuroradiologyMontreal Neurological HospitalMontrealCanada

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