Localization and registration accuracy in image guided neurosurgery: A clinical study

Purpose: To measure and compare the clinical localization and registration errors in image-guided neurosurgery, with the purpose of revising current assumptions. Materials and methods: Twelve patients who underwent brain surgeries with a navigation system were randomly selected. A neurosurgeon localized and correlated the landmarks on preoperative MRI images and on the intraoperative physical anatomy with a tracked pointer. In the laboratory, we generated 612 scenarios in which one landmark pair was defined as the target and the remaining ones were used to compute the registration transformation. Four errors were measured: (1) fiducial localization error (FLE); (2) target registration error (TRE); (3) fiducial registration error (FRE); (4) Fitzpatrick's target registration error estimation (F-TRE). We compared the different errors and computed their correlation. Results: The image and physical FLE ranges were 0.5-2.0 and 1.6-3.0 mm, respectively. The measured TRE, FRE and F-TRE were 4.1 ± 1.6, 3.9 ± 1.2, and 3.7 ± 2.2 mm, respectively. Low correlations of 0.19 and 0.37 were observed between the FRE and TRE and between the F-TRE and the TRE, respectively. The differences of the FRE and F-TRE from the TRE were 1.3 ± 1.0 mm (max = 5.5 mm) and 1.3 ± 1.2 mm (max = 7.3 mm), respectively. Conclusion: Contrary to common belief, the FLE presents significant variations. Moreover, both the FRE and the F-TRE are poor indicators of the TRE in image-to-patient registration.