Skip to content
BY-NC-ND 3.0 license Open Access Published by De Gruyter Open Access March 1, 2007

Image-to-patient registration by natural anatomical surfaces of the head

  • Rüdiger Marmulla EMAIL logo , Joachim Mühling and Georg Eggers
From the journal Open Medicine


The use of registration markers in computer-assisted surgery is combined with high logistic costs and efforts.

During the preparation of image guided surgery, automated markerless patient-to-image registration based on anatomical surfaces allows a significant reduction of preoperative effort and of the radiation dose the patient is exposed to. Placement and measurement of radio-opaque fiducial markers becomes unnecessary. The usability of face, auricle, maxilla and mandible for surface-based registration to CT image data was investigated. The present study was performed to evaluate the clinical accuracy in finding defined target points within the surgical site after markerless patient registration in image-guided oral and maxillofacial surgery.

Preoperatively, the spatial position of 20 patients was registered to CT image data using a 3D laser surface scanner. Indications for surgery were tumours, foreign bodies and skeletal malformations. The accuracy of this surface-based registration was verified using additionally placed fiducial markers.

The study showed, that markerless surface-based registration was sufficiently accurate for clinical use when the surface used for matching was the upper jaw, the face, or — with reservations — the auricle. Surface-based registration using the mandible did not yield satisfying results. To conclude, image-to-patient registration based on laser surface scanning is a valuable method for surgery of the head. Multiple sites of the head were identified as appropriate for the method. Hence, dependent on the individual case and the intended surgery, the registration area can be selected with the necessary flexibility.

[1] A. Burkart, R.E. Debski, P.J. McMahon, T. Rudy, F.H. Fu, V. Musahl, A. van Scyoc and S.L. Woo: “Precision of ACL tunnel placement using traditional and robotic techniques”, Comput. Aided. Surg., Vol. 6, (2001), pp. 270–278. in Google Scholar

[2] M.J. Magee and M.J. Mack: “Robotics and coronary artery surgery”, Curr. Opin. Cardiol., Vol. 17, (2002), pp. 602–607. in Google Scholar

[3] V. Musahl, A. Plakseychuk and F.H. Fu: “Current opinion on computer-aided surgical navigation and robotics: role in the treatment of sports-related injuries”, Sports Med., Vol. 32, (2002), pp. 809–818. in Google Scholar

[4] F. Watzinger, W. Birkfellner, F. Wanschitz, W. Millesi, C. Schopper, K. Sinko, K. Huber, H. Bergmann and R. Ewers: “Positioning of dental implants using computer aided navigation and an optical tracking system: case report and presentation of a new method”, J. Craniomaxillofac. Surg., Vol. 27, (1999), pp. 77–81. Search in Google Scholar

[5] J. Bier: “Robotik”, Mund Kiefer Gesichtschir, Vol. 4,Suppl. 1, (2000), pp. 356–368. in Google Scholar

[6] C. Cutting, R. Taylor, D. Khorramabadi, B. Haddad and J.G. McCarthy: “A virtual reality approach to intraoperative bone fragment positioning during craniofacial surgical procedures”, J. Craniofac. Surg., Vol. 6, (1995), pp. 33–37. in Google Scholar

[7] N.C. Gellrich, A. Schramm, B. Hammer, S. Rojas, D. Cufi, W. Lagreze and R. Schmelzeisen: “Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity”, Plast. Reconstr. Surg., Vol. 110, (2002), pp. 1417–1429. in Google Scholar

[8] J.G. Golfinos, B.C. Fitzpatrick, L.R. Smith and R.F. Spetzler: “Clinical use of a frameless stereotactic arm: Results of 325 cases”, J. Neurosurg., Vol. 83, (1995), pp. 197–205. Search in Google Scholar

[9] S. Hassfeld, J. M’uhling and J. Zöller: “Intraoperative navigation in oral and maxillofacial surgery”, Int. J. Oral. Maxillofac. Surg., Vol. 24, (1995), pp. 111–119. in Google Scholar

[10] R. Schmelzeisen, R. Schon, A. Schramm and N.C. Gellrich: “Computer-aided procedures in implantology, distraction and cranio-maxillofacial surgery”, Ann. R. Australas Coll. Dent. Surg., Vol. 16, (2002), pp. 46–49. Search in Google Scholar

[11] A. Schramm, N.C. Gellrich, R. Schimming and R. Schmelzeisen: “Rechnergestützte Insertion von Zygomatikumimplantaten (Branemark-System) nach ablativer Tumorchirurgie”, Mund. Kiefer Gesichtschir, Vol. 4, (2000), pp. 292–295. in Google Scholar PubMed

[12] F.D. Albritton, T.T. Kingdom and J.M. DelGaudio: “Malleable Registration Mask. Application of a Novel Registration Method in Image Guided Sinus Surgery”, Am. J. Rhinol., Vol. 15, (2001), pp. 219–224. Search in Google Scholar

[13] M. Cartellieri, F. Vorbeck and J. Kremser: “Comparison of Six Three-dimensional Navigation Systems During Sinus Surgery”, Acta Otolaryngol., Vol. 121, (2001), pp. 500–504. in Google Scholar

[14] M. Caversaccio, D. Zulliger, R. Bächler, L.P. Nolte and R. Hausler: “Practical Aspects for Optimal Registration (Matching) on the Lateral Skull Base With an Optical Frameless Computer-Aided Pointer System”, Am. J. Otol., Vol. 21, (2000), pp. 863–870. Search in Google Scholar

[15] J. Claes, E. Koekelkoren, F.L. Wuyts, G.M. Claes, L. van den Hauwe and P.H. van de Heyning: “Accuracy of computer navigation in ear, nose, throat surgery: the influence of matching strategy”, Arch. Otolaryngol. Head Neck Surg., Vol. 126, (2000), pp. 1462–1466. Search in Google Scholar

[16] A.R. Gunkel, W. Freysinger and W.F. Thumfart: “Experience with various 3-dimensional navigation systems in head and neck surgery”, Arch. Otolaryngol. Head Neck Surg., Vol. 126, (2000), pp. 390–395. Search in Google Scholar

[17] R. Heermann, P.R. Issing, H. Husstedt, H. Becker and T. Lenarz: “Einsatz des Navigationssystems MKM im Bereich der lateralen Schädelbasis”, Laryngorhinootologie, Vol. 80, (2001), pp. 569–575. in Google Scholar PubMed

[18] M.A. Howard 3rd, M.B. Dobbs, T.M. Simonson, W.E. LaVelle and M.A. Granner: “A noninvasive, reattachable skull fiducial marker system. Technical note”, J. Neurosurg., Vol. 83, (1995), pp. 372–376. in Google Scholar

[19] L. Klimek, M. Wenzel and R. Mösges: “Computer-assisted orbital surgery”, Ophthalmic Surg., Vol. 24, (1993), pp. 411–417. Search in Google Scholar

[20] R. Metson, R.E. Gliklich and M. Cosenza: “A comparison of image guidance systems for sinus surgery”, Laryngoscope, Vol. 108, (1998), pp. 1164–1170. in Google Scholar

[21] P.K. Plinkert, B. Plinkert, A. Hiller and J. Stallkamp: “Einsatz eines Roboters an der lateralen Schädelbasis. Evaluation einer robotergesteuerten Mastoidektomie am anatomischen Präparat”, HNO, Vol. 49, (2001), pp. 514–522. in Google Scholar

[22] B. Sedlmaier, A. Schleich, B. Ohnesorge and S. Jovanovic: “Das NEN-HNO-Navigationssystem. Erste klinische Anwendung”, HNO, Vol. 49, (2001), pp. 523–529. in Google Scholar

[23] R. Bucholz, W. Macneil, P. Fewings, A. Ravindra, L. McDurmont and C. Baumann: “Automated rejection of contaminated surface measurements for improved surface registration in image guided neurosurgery”, Studies in Health Technology and Informatics, Vol. 70, (2000), pp. 39–45. Search in Google Scholar

[24] J. Kozak, M. Nesper, M. Fischer, T. Lutze, A. Goggelmann, S. Hassfeld and T. Wetter: “Semiautomated registration using new markers for assessing the accuracy of a navigation system”, Comput. Aided Surg., Vol. 7, (2002), pp. 11–24. in Google Scholar

[25] R. Marmulla, S. Hassfeld, T. L’uth and J. Mühling: “Laser-scan-based navigation in craniomaxillofacial surgery”, J. Craniomaxillofac Surg., Vol. 31, (2003), pp. 267–277. Search in Google Scholar

[26] A. Raabe, R. Krishnan, R. Wolff, E. Herrmann, M. Zimmermann and V. Seifert: “Laser Surface Scanning for Patient Registration in Intracranial Image-guided Surgery”, Neurosurgery, Vol. 50, (2002), pp. 797–803. in Google Scholar

[27] G. Santler: “The Graz hemisphere splint: a new precise, non-invasive method of replacing the dental arch of 3D-models by plaster models”, J. Cranio-Maxillofac. Surg., Vol. 26, (1998), pp. 169–173. in Google Scholar

[28] R. Marmulla and H. Niederdellmann: “Surgical planning of computer-assisted repositioning osteotomies”, Plast. Reconstr. Surg., Vol. 104, (1999), pp. 938–944. Search in Google Scholar

[29] R. Marmulla and T. Lüth: “Method and device for instrument, bone segment, tissue and organ navigation”, United States Patent 7.079.885, 2006. Search in Google Scholar

[30] Minolta, technical notes: Search in Google Scholar

[31] I.N. Bronstein and K.A. Semendjejeww: Taschenbuch der Mathematik, Teubner, Stuttgart, 1991. Search in Google Scholar

[32] R. Marmulla, M. Hilbert and H. Niederdellmann: “Inherent precision of mechanical, infrared and laser-guided navigation systems for computer-assisted surgery”, J. Craniomaxillofac Surg., Vol. 25, (1997), pp. 192–197. Search in Google Scholar

[33] W. Korb, T. Bodenmüller and G. Eggers: “Surface-based image-to-patient-registration using a hand-guided laser-range scanner system”, In: H.U. Lemke, M.W. Vannier, K. Inamura, A.G. Farman, K. Doi and J.H.C. Reiber (Eds.): International Congress Series 1268 Proceedings of the 18 th International Congress and Exhibition CARS 2004, Elsevier, Amsterdam, 2004, p. 1326. Search in Google Scholar

[34] R. Marmulla, J. Mühling, T. Lüth and S. Hassfeld: “Image-to-Patient-Registration by the natural anatomical surfaces of the auricle, mandible, and maxilla”, In: H.U. Lemke, M.W. Vannier, K. Inamura, A.G. Farman, K. Doi and J.H.C. Reiber (Eds.): International Congress Series 1268 Proceedings of the 18 th International Congress and Exhibition CARS 2004, Elsevier, Amsterdam, 2004, pp. 1192–1197. Search in Google Scholar

[35] J.M. Fitzpatrick and J.B. West: “The distribution of target registration error in rigid-body point-based registration”, IEEE Trans Med. Imaging, Vol. 20, (2001), pp. 917–927. in Google Scholar PubMed

[36] J. Schlaier, J. Warnat and A. Brawanski: “Registration accuracy and practicability of laser-directed surface matching”, Comput. Aided Surg., Vol 7, (2002), pp. 284–290. in Google Scholar PubMed

[37] R. Marmulla, T. Lüth, J. Mühling and S. Hassfeld: “Automated laser registration in image-guided surgery: evaluation of the correlation between laser scan resolution and navigation accuracy”, Int. J. Oral Maxillofac Surg., Vol. 33, (2004), pp. 642–648. in Google Scholar PubMed

[38] A. Morris: Bone Registration and Tracking using an Optical Tracking System, Thesis (M.Sc.), Johns Hopkins University. Baltimore, MD, USA, 2001. Search in Google Scholar

Published Online: 2007-3-1
Published in Print: 2007-3-1

© 2007 Versita Warsaw

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Downloaded on 3.6.2023 from
Scroll to top button