Registration of head CT images to physical space using a weighted combination of points and surfaces image-guided surgery

Most previously reported registration techniques that align three-dimensional image volumes by matching geometrical features such as points or surfaces use a single type of feature. We recently reported a hybrid registration technique that uses a weighted combination of multiple geometrical feature shapes. In this study we use the weighted geometrical feature (WGF) algorithm to register computed tomography (CT) images of the head to physical space using the skin surface only, the bone surface only, and various weighted combinations of these surfaces and one fiducial point (centroid of a bone-implanted marker). We use data acquired from 12 patients that underwent temporal lobe craniotomies for the resection of cerebral lesions. We evaluate and compare the accuracy of the registrations obtained using these various approaches by using as a reference gold standard the registration obtained using three bone-implanted markers. The results demonstrate that a combination of geometrical features can improve the accuracy of CT-to-physical space registration. Point-based registration requires a minimum of three noncolinear points. The position of a bone-implanted marker can be determined much more accurately than that of a skin-affixed marker or an anatomic landmark. A major disadvantage of using bone-implanted markers is that an invasive procedure is required to implant each marker. By combining surface information, the WGF algorithm allows registration to be performed using only one or two such markers. One important finding is that the use of a single very accurate point (a bone-implanted marker) allows very accurate surface-based registration to be achieved using very few surface points. Finally, the WGF algorithm, which not only allows the combination of multiple types of geometrical information but also handles point-based and surface-based registration as degenerate cases, could form the foundation of a "flexible" surgical navigation system that allows the surgeon to use what he considers the method most appropriate for an individual clinical situation.