The accuracy of image guided surgery based on cone beam computer tomography image data

Objective. The objective of this study was to verify if accurate patient-to-image registration for precision navigation in maxillofacial surgery is possible based on cone beam computed tomography (CBCT) image data. Study design. A maxillary registration template was placed on a standard plastic skull phantom that was equipped with a custom made model of the maxilla and with target markers. Imaging was performed with a CBCT device (Newtom 9000 Digital Volume Tomograph (DVT), QR s.r.l., Verona, Italy) and a computed tomography (CT) scanner (Somatom 4, Siemens, Forchheim, Germany). Using an infrared navigation system (Polaris, NDI, Waterloo, Ontario), multiple pair-point registration of both image data sets and the phantom were performed. The target registration error (TRE) was evaluated. Results. A total of 243 registrations were performed for either image data set. The spatial distribution of TRE on the skull showed increasing inaccuracy with growing distance from the registration markers. The average target registration error was 1.50 +/- 0.82 mm with CBCT and 1.57 +/- 0.84 mm with CT image data and did not differ significantly. Error distribution correlated strongly between CT- and CBCT-based registration. Conclusions. The overall registration accuracy based on CBCT image data was similar to CT. The strong correlation of the geometric distribution of TRE between CT-and CBCT-based measurements proves that CBCT can be equivalent to CT in image-guided maxillofacial surgery. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e41-e48)