A feedback system for instrument guidance includes a feedback guidance module (122) configured to detect an instrument in a realtime image and generate feedback under a detected event for aligning or guiding the instrument. An image generation module (148) is configured to generate a projected guideline in the image. The feedback guidance module is configured to generate at least one of audio and visual feedback to provide guidance to a user in positioning the instrument in the area of interest relative to the projected guideline in realtime.