High accuracy and precision are essential in stereotactic neurosurgery, as targeting errors can significantly affect clinical outcomes. Image registration is a vital step in stereotaxis, and understanding the error associated with different image registration methods is important to inform the choice of equipment and techniques in stereotactic neurosurgery. The authors aimed to quantify the test-retest reliability and stereotactic accuracy of cone-beam CT (CBCT) compared with the current clinical gold-standard technique (i.e., CT).

Two anthropomorphic phantom models with 40 independent unique steel spheres were developed to compare CBCT frame and stereotactic space registration with the clinical gold standard (CT). The cartesian coordinates of each sphere were compared between the imaging modalities for test-retest reliability and overall accuracy.

Both imaging modalities showed similar levels of fiducial deviation from the expected geometry. The equivalence test demonstrated mean differences between CT and CBCT registration of −0.082 mm (90% CI −0.27 to 0.11), −0.045 mm (90% CI −0.43 to 0.34), and −0.041 mm (90% CI −0.064 to 0.018) for coordinates in the x-, y-, and z-axes, respectively. The mean euclidean distance difference between the two modalities was 0.28 mm (90% CI 0.27–0.29).

Accuracy and precision were comparable between CBCT and CT image registrations. These findings suggest that CBCT registration can be used as a clinically equivalent substitute to gold-standard CT acquisition.

高精度和高精度对于立体定向神经外科手术至关重要，因为定位错误会显着影响临床结果。图像配准是立体定向的重要步骤，了解与不同图像配准方法相关的误差对于立体定向神经外科设备和技术的选择非常重要。作者旨在量化锥形束 CT (CBCT) 与当前临床金标准技术（即 CT）相比的重测可靠性和立体定向准确性。

开发了两种具有 40 个独立独特钢球的拟人体模模型，用于将 CBCT 框架和立体定向空间配准与临床金标准 (CT) 进行比较。比较了成像模式之间每个球体的笛卡尔坐标，以确保重测可靠性和总体准确性。

两种成像方式均显示出与预期几何形状的基准偏差水平相似。等效性测试表明，CT 和 CBCT 配准之间的平均差异为 -0.082 mm（90% CI -0.27 至 0.11）、-0.045 mm（90% CI -0.43 至 0.34）和 -0.041 mm（90% CI -0.064 至 0.018） ) 分别表示 x、y 和 z 轴的坐标。两种模式之间的平均欧氏距离差异为 0.28 mm (90% CI 0.27–0.29)。

CBCT 和 CT 图像配准的准确性和精密度相当。这些发现表明 CBCT 配准可以作为金标准 CT 采集的临床等效替代品。