Ultrasound examinations in the shoulder area are nowadays usually limited to evaluating conventional, two-dimensional (2D) images acquired in predefined, standardized acquisition orientations This greatly restricts the field of view which is thus provided to inspect the three-dimensional (3D) geometry of the joint and places high demands on the physician's ability to correctly place the scanhead and interpret the images. When considering ultrasound imaging for use in a surgical planning scenario, e.g. for the implantation of the humeral part of a shoulder prosthesis, the conventional, 2D imaging technique must be extended to three dimensions; a (semi-) automatic segmentation as well as interpretation, i.e. for determining 3D measures which can be utilized in the planning process, is also desired. In this study, we evaluated the feasibility of a purely 3D ultrasound based approach for the navigated, anatomically optimized implantation of the humeral part of a shoulder prosthesis. Keywords 3D ultrasound AE Shoulder endoprosthesis AE Navigated implantation 1 Introduction Surgical planning for shoulder joint replacements is nowadays usually performed based two-dimensional (2D) X-Ray imaging or -when deemed necessary -on additional CT or MRI imaging. Apart from being time consuming and expensive, X-Ray imaging as well as CT also expose the patient to ionizing radiation. On the other hand, conventional, 2D sonography of the shoulder joint is a well-established, standardized and cost-effective method and is commonly used for various diagnostic evaluations in several so called standard acquisition orientations [1]. Nevertheless, by using a 2D technique to depict the joint's three-dimensional (3D) anatomy, a number of limitations become apparent: every investigation highly depends on the physician's abilities to correctly place the scanhead and to interpret the recorded images. This can lead to a considerable variability in the diagnostic results [2]. Determining 3D measures from 2D data -which is a prerequisite for applying ultrasound imaging techniques for use in surgical planning -is impossible. For making use of sonography's full potential, technical improvements such as 3D freehand acquisition of ultrasound volumes coupled with a (semi-) automatic segmentation and interpretation of the reconstructed volume data become a necessity. In this study, we evaluated the use of freehand acquired ultrasound volumes for their applicability in surgical planning and navigated implantation of the humeral part of a shoulder endoprosthesis. 2 Materials and methods Image volumes of the upper arms of several healthy volunteers (containing between 1,000 and 1,500 slices each) were acquired in several overlapping, manually controlled freehand sweeps using a conventional 2D ultrasound imaging system (Nemio TM SSA-550A, Toshiba, Tokyo, Japan); a localizer system (6 DOF, Polaris TM , Northern Digital Inc., Waterloo, ON, Canada) was fixed to the transducer. To ensure geometric accuracy, a calibration was performed to establish the rigid bod...