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The registration accuracy of skin- and bone-implanted fiducials using a frameless stereotactic system were analyzed prospectively.
Twenty-eight patients underwent resection of intra-axial neoplasmas after both skin- and bone-implantable fiducial markers were placed. Both sets of fiducials were independently co-registered to a magnetic resonance imaging data set acquired preoperatively using the ISG Viewing Wand™. Root mean square errors were recorded as an objective measure of registration accuracy of the two types of fiducials.
Root mean square errors of bone-implanted fiducials registration were lower than those of skin fiducials; however, this difference was not statistically significant (p = 0.206).
The registration accuracy of skin- and bone-implanted fiducials appears to be similar. Still, bone-implanted fiducials may be advantageous compared to skin fiducials when re-registration of the patient-image space is desired intraoperatively such as during major drift in the patient's position or after surgical repositioning.