Image fusion on the endoscopic view for endo-nasal skull-base surgery

Marco Lai, Caifeng Shan, Drazenko Babic, Robert Homan, Adrian Elmi Terander, Erik Edstrom, Oscar Persson, Gustav Burstrom, Peter H.N. de With

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

5 Citations (Scopus)


The use of pre-operative CT and MR images for navigation during endo-nasal skull-base endoscopic surgery is a well-established procedure in clinical practice. Fusion of CT and MR images on the endoscopic view can offer an additional advantage by directly overlaying surgical-planning information in the surgical view. Fusion of intraoperative images, such as cone beam computed tomography (CBCT), represents a step forward since these images can also account for intra-operative anatomical changes. In this work, we present a method for intra-operative CBCT image fusion on the endoscopic view for endo-nasal skull-base surgery, implemented on the Philips surgical navigation system. This is the first study which utilizes an optical tracking system (OTS) embedded in the flat-panel detector of the C-arm for endoscopic-image augmentation. In our method the OTS, co-registered in the same CBCT coordinate system, is used for tracking the endoscope. Accuracy in CBCT image registration in the endoscopic view is studied using a calibration board. Image fusion is tested in a realistic surgical scenario by using a skull phantom and inserts that mimic critical structures at the skull base. Overall performances tested on the skull phantom show a high accuracy in tracking the endoscope and registration of CBCT on endoscopic view. It can be concluded that the implemented system show potential for usage in endo-nasal skull-base surgery.

Original languageEnglish
Title of host publicationMedical Imaging 2019
Subtitle of host publicationImage-Guided Procedures, Robotic Interventions, and Modeling
EditorsBaowei Fei, Cristian A. Linte
Place of PublicationBellingham
Number of pages8
ISBN (Electronic)9781510625495
Publication statusPublished - 8 Mar 2019
EventSPIE Medical Imaging 2019 - San Diego, United States
Duration: 16 Feb 201921 Feb 2019

Publication series

NameProceedings of SPIE


ConferenceSPIE Medical Imaging 2019
Country/TerritoryUnited States
CitySan Diego


  • Augmented reality
  • Endoscopic camera
  • Image fusion
  • Image-guided surgery
  • Minimally-invasive neurosurgery
  • Skull-base surgery
  • Surgical navigation system
  • endoscopic camera
  • skull-base surgery
  • minimally-invasive neurosurgery


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