| CPC A61B 34/20 (2016.02) [A61B 6/032 (2013.01); A61B 6/4085 (2013.01); A61B 6/583 (2013.01); A61B 34/10 (2016.02); A61B 34/30 (2016.02); G06T 7/337 (2017.01); G06T 7/73 (2017.01); A61B 2034/102 (2016.02); A61B 2090/3764 (2016.02); A61B 2090/3966 (2016.02); A61B 2090/3983 (2016.02); G06T 2200/04 (2013.01); G06T 2207/10081 (2013.01); G06T 2207/10116 (2013.01); G06T 2207/30008 (2013.01)] | 21 Claims |

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1. A method for determining an optimal position of a surgical instrument relative to a tracker attached to a patient's bone using a cone beam computed tomography (CBCT) imaging system and a computer, the method comprising the following steps:
(a) receiving at least one preoperative 2D X-ray image of the bone while the patient is in a posture of interest, the posture of interest being a posture that has an impact on a configuration of the bone and on interaction of the bone with other anatomical structures of the patient;
(b) acquiring an intraoperative 3D CBCT medical image of the bone by the cone beam computed tomography (CBCT) imaging system while the patient is in an operative posture, in which a position and an orientation of the bone relative to another anatomical structure of the patient is different from the one in the posture of interest, the intraoperative 3D CBCT medical image being registered with the coordinate system of the bone tracker;
(c) registering with the computer the intraoperative 3D CBCT medical image onto the at least one preoperative 2D X-ray image, so as to obtain a registered 3D CBCT medical image representing the bone in the posture of interest;
(d) planning with the computer a surgical procedure on the registered 3D medical image taking into account said posture of interest;
(e) determining with the computer an optimal position of the surgical instrument relative to the patient's bone tracker for implementing said planned surgical procedure.
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