An image registration system (111) for registering a live stream of ultrasound images (112) of a beamforming ultrasound probe (113) with an X-ray image (114) is described. The image registration (111) system identifies, from the X-ray image (114), the position of a medical device (116) represented in the X-ray image (114)； and determines, based on ultrasound signals transmitted between the beamforming ultrasound probe (113) and an ultrasound transducer (115) disposed on the medical device (116), a location of the ultrasound transducer (115) respective the beamforming ultrasound probe (113). Each ultrasound image from the live stream (112) is registered with the X-ray (114) image based on the identified position of the medical device (116). The registration includes determining an offset from said identified position that is based on i) a predetermined spatial relationship of the ultrasound transducer (115) respective the medical device (116) and ii) the determined location of the ultrasound transducer (115) respective the beamforming ultrasound probe (113).
