Presented herein are methods, systems, devices, and computer-readable media for image annotation in image-guided medical procedures. Some embodiments herein allow physicians or other operators to use one or more medical devices in order to define annotations in 3D space. These annotations may later be displayed to the physician or operator in 3D space in the position in which they were first drawn or otherwise generated. In some embodiments, the operator may use various available medical devices, such as needles, scalpels, or even a finger in order to define the annotation. Embodiments herein may allow an operator to more conveniently and efficiently annotate visualizable medical data.