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Medical navigation systems for orthopedic surgery are becoming more and more important with the increasing proportion of older people in the population, and hence the increasing incidence of diseases of the musculoskeletal system. The central problem for such systems is the exact transformation of the preoperatively acquired datasets to the coordinate system of the patient's body, which is crucial for the accuracy of navigation. Our approach, based on the use of intraoperative ultrasound for image registration, is capable of robustly registering bone structures for different applications, e.g., at the spine or the knee. Nevertheless, this new procedure demands additional steps of preparation of preoperative data. To increase the clinical acceptance of this procedure, it is useful to automate most of the data processing steps. In this article, we present the architecture of our system with focus on the automation of the data processing steps. In terms of accuracy, a mean target registration error of 0.68 mm was achieved for automatically segmented and registered phantom data where the reference transformation was obtained by performing point-based registration using artificial structures. As the overall accuracy for subject data cannot be determined non-invasively, automatic segmentation and registration were judged by visual inspection and precision, which showed a promising result of 1.76 mm standard deviation for 100 registration trials based on automatic segmentation of magnetic resonance imaging data of the spine.

We have demonstrated the feasibility of registering bone structures based on 3D-ultrasound and MRI data. Our method allows for minimally invasive routine surgery of orthopaedic diseases which so far had to be operated conventionally because other methods for navigated surgery are too expensive, inaccurate or time-consuming.