Minimization of target registration error for vertebra in image-guided spine surgery

  • Marzieh Ershad
  • Alireza AhmadianEmail author
  • Nassim Dadashi Serej
  • Hooshang Saberi
  • Keyvan Amini Khoiy
Original Article



   The accuracy of pedicle screw placement during image-guided spine surgery (IGSS) can be characterized by estimating the target registration error (TRE). The major factors that influence TRE were identified, minimized, and verified with in vitro experiments.

Materials and methods 

    Computed-tomography-compatible markers are placed over anatomical landmarks of lumbar vertebral segments in locations that are feasible and routinely used in surgical procedures. TRE was determined directly for markers placed on the pedicles of vertebra segments. First, optimum selections of landmarks are proposed for different landmarks according to the minimum achievable TRE values in different configurations. These anatomical landmarks are feasible and accessible to overcome constraints that may be imposed during surgical procedures. Second, the effect of fiducial weighting on corresponding points to overcome anisotropic localization error based on maximum likelihood approach is evaluated. Third, an experimental model for fiducial localization error (FLE) is derived to obtain the weights. At the end, an error zone was obtained for each marker to indicate the possible acceptable deviation from the marker’s exact location in practice. This study was performed in vitro on a spine phantom.


   Optimal landmark selection led to a 30 % reduction in TRE. In addition, optimum weighting of the fiducials in an FLE model that incorporates anisotropic localization error in the registration algorithm led to a 28 % reduction in the TRE.


   Landmark configuration, transformation parameters, and fiducial localization error are factors that significantly affect the total TRE. These factors should be optimized to minimize the TRE. Both the optimum configuration of landmarks and the anisotropic weighing of fiducials have significant impact on the registration accuracy for IGSS.


Target registration error Fiducial localization error  Rigid registration Image-guided surgery 



The authors would like to thank the reviewers for carefully reading the paper and providing valuable comments and suggestions. The first author would also like to thank Professor J. Michael Fitzpatrick for helpful communication.

Conflict of Interest

Marzieh Ershad, Alireza Ahmadian, Nassim Dadashi Serej, Hooshang Saberi, and Keyvan Amini Khoiy declare that they have no conflict of interest


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Copyright information

© CARS 2013

Authors and Affiliations

  • Marzieh Ershad
    • 1
    • 2
  • Alireza Ahmadian
    • 1
    • 2
    Email author
  • Nassim Dadashi Serej
    • 1
    • 2
  • Hooshang Saberi
    • 3
    • 4
  • Keyvan Amini Khoiy
    • 5
    • 6
  1. 1.Department of Biomedical Systems and Medical PhysicsTehran University of Medical SciencesTehranIran
  2. 2.Image Guided Intervention GroupResearch Center for Biomedical Technology and Robotics (RCBTR)TehranIran
  3. 3.Department of Neurosurgery, Imam Khomeini HospitalTehran University of Medical SciencesTehranIran
  4. 4.Brain and Spinal Injuries Repair Research Center (BASIR)Imam Khomeini Complex HospitalTehranIran
  5. 5.Department of Mechanical EngineeringSharif University of TechnologyTehranIran
  6. 6.Parseh Intelligent Surgical SystemPARSISS CompanyTehranIran

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