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Transesophageal high-intensity focused ultrasound (HIFU) energy can be used to treat cardiac arrhythmia efficiently non-invasively. Since the esophagus is located just behind the heart, it offers a perfect acoustic window. Hence, HIFU can be directed toward the heart to perform ablation. In a previous study a HIFU probe with one 2D US image perpendicular to the esophagus axis for guidance purpose has been proposed. A new dual-mode HIFU probe with two perpendicular 2D US imaging plane is now under development. In this paper we propose a therapy guidance system, based on an intensity-based registration of the two perpendicular 2D US to preoperative 3D CT. As a proof of concept we developed the following evaluation framework on a numerical phantom: 1) we define a ground truth (GT) initial pose inside a CT volume and simulated two perpendicular US images from the CT data; 2) we run the registration framework from 55 randomly defined pose initializations around the initial GT pose; and 3) we estimated the accuracy of the registration by (a) the transformation parameter estimation errors and (b) Target Registration Error (TRE). The accuracy of the registration using two 2D US plane has been compared to the previous work performed on only one US plane. An improvement was observed when using two 2D US planes with regards to the previous one US plane.

High-Intensity Focused Ultrasound (HIFU) Therapy Guidance System by Image-Based Registration for Patients With Cardiac Fibrillation