• Ian J Gerard, Jeffery A Hall, Kelvin Mok, and D Louis Collins.
• *McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada; ‡Department of Biomedical Engineering, McGill University, Montreal, Quebec, Canada; §Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada; ¶Neuronavigation Unit, Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.
• Neurosurgery. 2015 Sep 1;11 Suppl 3:376-80; discussion 380-1.

BackgroundNewer versions of the commercial Medtronic StealthStation allow the use of only 8 landmark pairs for patient-to-image registration as opposed to 9 landmarks in older systems. The choice of which landmark pair to drop in these newer systems can have an effect on the quality of the patient-to-image registration.ObjectiveTo investigate 4 landmark registration protocols based on 8 landmark pairs and compare the resulting registration accuracy with a 9-landmark protocol.MethodsFour different protocols were tested on both phantoms and patients. Two of the protocols involved using 4 ear landmarks and 4 facial landmarks and the other 2 involved using 3 ear landmarks and 5 facial landmarks. Both the fiducial registration error and target registration error were evaluated for each of the different protocols to determine any difference between them and the 9-landmark protocol.ResultsNo difference in fiducial registration error was found between any of the 8-landmark protocols and the 9-landmark protocol. A significant decrease (P < .05) in target registration error was found when using a protocol based on 4 ear landmarks and 4 facial landmarks compared with the other protocols based on 3 ear landmarks.ConclusionWhen using 8 landmarks to perform the patient-to-image registration, the protocol using 4 ear landmarks and 4 facial landmarks greatly outperformed the other 8-landmark protocols and 9-landmark protocol, resulting in the lowest target registration error.

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