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Registration of intraoperative fluoroscopy images with preoperative 3D CT images can he used for several purposes in image-guided surgery. On the one hand, it can be used to display the position of surgical instruments, which are being tracked by a localizer, in the preoperative CT scan. On the other hand, the registration result can be used to project preoperative planning information or important anatomical structures visible in the CT image on to the fluoroscopy image. For this registration task, a novel voxel-based method in combination with a new similarity measure (pattern intensity) has been developed. The basic concept of the method is explained at the example of 2D/3D registration of a vertebra in an X-ray fluoroscopy image with a 3D CT image. The registration method is described, and the results for a spine phantom are presented and discussed. Registration has been carried out repeatedly with different starting estimates to study the capture range. Information about registration accuracy has been obtained by comparing the registration results with a highly accurate "ground-truth" registration, which has been derived from fiducial markers attached to the phantom prior to imaging. In addition, registration results for different vertebrae have been compared. The results show that the rotation parameters and the shifts parallel to the projection plane can accurately be determined from a single projection. Because of the projection geometry, the accuracy of the height above the projection plane is significantly lower.