Feasibility and accuracy of a comprehensive navigation registration strategy for image-guided craniomaxillofacial...

Precise image registration is essential for the success of image-guided craniomaxillofacial robotic surgery (IGCRS). However, current methods fail to meet the diverse needs of various craniomaxillofacial procedures. In this study, a comprehensive navigation registration strategy was developed including three techniques: removable marker (RM) registration, intraoral scan-CBCT (IOS) registration, and marker-relay (MR) registration. A phantom study was conducted using four three-dimensionally printed skulls with 20 target points each. Registration accuracy was assessed using fiducial registration error (FRE) and target registration error (TRE), with a U-shaped tube fixed marker (FM) as the control. The mean FRE for FM, RM, IOS, and MR was 0.07 ± 0.01 mm, 0.08 ± 0.04 mm, 0.15 ± 0.03 mm, and 0.14 ± 0.05 mm, respectively, with IOS and MR showing higher FRE than FM and RM. The mean TRE was 0.39 ± 0.03 mm (FM), 0.40 ± 0.03 mm (RM), 0.43 ± 0.03 mm (IOS), and 0.42 ± 0.02 mm (MR). Statistical analysis confirmed non-inferiority of all three techniques compared to the control. In conclusion, this strategy demonstrated accuracy and feasibility, offering a foundation for advancements in IGCRS surgery. Further experiments and clinical trials are necessary to validate these techniques in actual robotic surgeries.