A hybrid registration method using the mandibular bone surface for electromagnetic navigation in mandibular surgery

A. F. de Geer, M. J.A. van Alphen*, C. L. Zuur, A. J. Loeve, R. L.P. van Veen, M. B. Karakullukcu

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)
53 Downloads (Pure)


Purpose: To utilize navigated mandibular (reconstructive) surgery, accurate registration of the preoperative CT scan with the actual patient in the operating room (OR) is required. In this phantom study, the feasibility of a noninvasive hybrid registration method is assessed. This method consists of a point registration with anatomic landmarks for initialization and a surface registration using the bare mandibular bone surface for optimization. Methods: Three mandible phantoms with reference notches on two osteotomy planes were 3D printed. An electromagnetic tracking system in combination with 3D Slicer software was used for navigation. Different configurations, i.e., different surface point areas and number and configuration of surface points, were tested with a dentate phantom (A) in a metal-free environment. To simulate the intraoperative environment and different anatomies, the registration procedure was also performed with an OR bed using the dentate phantom and two (partially) edentulous phantoms with atypical anatomy (B and C). The accuracy of the registration was calculated using the notches on the osteotomy planes and was expressed as the target registration error (TRE). TRE values of less than 2.0 mm were considered as clinically acceptable. Results: In all experiments, the mean TRE was less than 2.0 mm. No differences were found using different surface point areas or number or configurations of surface points. Registration accuracy in the simulated intraoperative setting was—mean (SD)—0.96 (0.22), 0.93 (0.26), and 1.50 (0.28) mm for phantom A, phantom B, and phantom C. Conclusion: Hybrid registration is a noninvasive method that requires only a small area of the bare mandibular bone surface to obtain high accuracy in phantom setting. Future studies should test this method in clinical setting during actual surgery.

Original languageEnglish
Pages (from-to)1343-1353
Number of pages11
JournalInternational journal of computer assisted radiology and surgery
Issue number7
Early online date20 Apr 2022
Publication statusPublished - Jul 2022
Externally publishedYes

Bibliographical note

Funding Information:
The authors thank the clinical implementation team from the Netherlands Cancer Institute for using their equipment and for their help during the conceptualization of the experiments.

Publisher Copyright:
© 2022, CARS.


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