Accuracy evaluation of initialization-free registration for intraoperative 3D-navigation

Purpose An initialization-free approach for perioperative registration in functional endoscopic sinus surgery (FESS) is sought. The quality of surgical navigation relies on registration accuracy of preoperative images to the patient. Although landmark-based registration is fast, it is prone to human operator errors. This study evaluates the accuracy of two well-known methods for segmentation of the occipital bone from CT-images for use in surgical 3D-navigation. Method The occipital bone was segmented for registration without pre-defined correspondences, with the iterative closest point algorithm (ICP). The thresholding plus marching cubes segmentation (TMCS), and the deformable model segmentation (DMS) were compared quantitatively by overlaying the areas of the segmentations in cross-sectional slices, and visually by displaying the pointwise distances between the segmentations in a three-dimensional distance map relative to an expert manual segmentation, taken as a “ground truth”. Results Excellent correspondence between the two methods was achieved; the results showed, however, that the TMCS is closer to the “ground truth”. This is due to the sub-voxel accuracy of the marching cubes algorithm by definition, and the sensitivity of the DMS method to the choice of parameters. The DMS approach, as a gradient-based method, is insensitive to the thresholding initialization. For noisy images and soft tissue delineation a gradient-based method, like the deformable model, performs better. Both methods correspond within minute differences less than 4%. Conclusion These results will allow further minimization of human interaction in the planning phase for intraoperative 3D-navigation, by allowing to automatically create surface patches for registration purposes, ultimately allowing to build an initialization-free, fully automatic registration procedure for navigated Ear-, Nose-, Throat- (ENT) surgery.