Embodiments of the invention provide a system and method that is able to automatically provide a starting point for 2D to 3D image registration, without relying on human recognition of features shown in the 2D image. This is achieved by pre-processing the 3D data to obtain synthetically generated 2D images of those parts of the 3D data volume which will be used for registration purposes. Many different synthetically generated 2D images of the or each part of the 3D volume are produced, each from a different possible viewing direction. Each of these synthetic images is then subject to a feature extraction process to extract characterising feature data of the registration feature shown in the images. Once the feature extraction has been undertaken for each image, when registration is to be performed the real-time 2D image is processed by applying each of the sets of extracted features thereto, to try and identify which set best matches the registration features in the 2D image. For example, where a generalised Hough transform was used in the feature extraction, the R tables would be applied to the 2D image to obtain respective accumulation images. The accumulation images may then be ranked to identify which registration feature is shown in the 2-D image, and from which view direction. This gives the required information of which registration feature is being shown in the 2D image, and also the in-plane location and orientation. This information can then be used as a starting point for the 2D to 3D registration procedure.
