# Automatic Multi-View X-Ray/CT Registration Using Bone Substructure Contours

arXiv: https://arxiv.org/abs/2506.13292 · HTML: https://mlsanity.com/paper/2506.13292/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 10 of its 29 references that are in the map.
- First posted on arXiv 16 Jun 2025.

## Builds on (most cited first, 10 of 10)

- [DeepEdge: A Multi-Scale Bifurcated Deep Network for Top-Down Contour Detection](https://mlsanity.com/paper/1412.1123/) (2014)
- [Skeleton Recall Loss for Connectivity Conserving and Resource Efficient Segmentation of Thin Tubular Structures](https://mlsanity.com/paper/2404.03010/) (2024)
- [Automatic Annotation of Hip Anatomy in Fluoroscopy for Robust and Efficient 2D/3D Registration](https://mlsanity.com/paper/1911.07042/) (2019)
- [Intraoperative 2D/3D Image Registration via Differentiable X-ray Rendering](https://mlsanity.com/paper/2312.06358/) (2023)
- [Multiview 2D/3D Rigid Registration via a Point-Of-Interest Network for Tracking and Triangulation (POINT2)](https://mlsanity.com/paper/1903.03896/) (2019)
- [Real-time 2D/3D Registration via CNN Regression](https://mlsanity.com/paper/1507.07505/) (2015)
- [Self-Supervised 2D/3D Registration for X-Ray to CT Image Fusion](https://mlsanity.com/paper/2210.07611/) (2022)
- [Pose Estimation of Periacetabular Osteotomy Fragments with Intraoperative X-Ray Navigation](https://mlsanity.com/paper/1903.09339/) (2019)
- [Augmenting Medical Imaging: A Comprehensive Catalogue of 65 Techniques for Enhanced Data Analysis](https://mlsanity.com/paper/2303.01178/) (2023)
- [Deep Iterative 2D/3D Registration](https://mlsanity.com/paper/2107.10004/) (2021)

## Built on by (most cited first, 1 of 1)

- [Electromagnetic Navigation for Femoral Osteotomy Using High-Accuracy X-ray-to-CT Registration](https://mlsanity.com/paper/2606.03893/) (2026)

## Abstract (arXiv)

Purpose: Accurate intraoperative X-ray/CT registration is essential for surgical navigation in orthopedic procedures. However, existing methods struggle with consistently achieving sub-millimeter accuracy, robustness under broad initial pose estimates or need manual key-point annotations. This work aims to address these challenges by proposing a novel multi-view X-ray/CT registration method for intraoperative bone registration. Methods: The proposed registration method consists of a multi-view, contour-based iterative closest point (ICP) optimization. Unlike previous methods, which attempt to match bone contours across the entire silhouette in both imaging modalities, we focus on matching specific subcategories of contours corresponding to bone substructures. This leads to reduced ambiguity in the ICP matches, resulting in a more robust and accurate registration solution. This approach requires only two X-ray images and operates fully automatically. Additionally, we contribute a dataset of 5 cadaveric specimens, including real X-ray images, X-ray image poses and the corresponding CT scans. Results: The proposed registration method is evaluated on real X-ray images using mean reprojection error (mRPD). The method consistently achieves sub-millimeter accuracy with a mRPD 0.67mm compared to 5.35mm by a commercial solution requiring manual intervention. Furthermore, the method offers improved practical applicability, being fully automatic. Conclusion: Our method offers a practical, accurate, and efficient solution for multi-view X-ray/CT registration in orthopedic surgeries, which can be easily combined with tracking systems. By improving registration accuracy and minimizing manual intervention, it enhances intraoperative navigation, contributing to more accurate and effective surgical outcomes in computer-assisted surgery (CAS).