The fusion of tracked ultrasound with CT has benefits for a variety of clinical applications, however extensive manual effort is usually required for correct registration. We developed new methods that allow one to simulate medical ultrasound from CT in real-time, reproducing the majority of ultrasonic imaging effects. They are combined with a robust similarity measure that assesses the correlation of a combination of signals extracted from CT with ultrasound, without knowing the influence of

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... ch signal. This serves as the foundation of a fully automatic registration, that aligns a 3D ultrasound sweep with the corresponding tomographic modality using a rigid or an affine transformation model, without any manual interaction. These techniques were evaluated in a study involving 25 patients with indeterminate lesions in liver and kidney. The clinical setup, acquisition and registration workflow is described, along with the evaluation of the registration accuracy with respect to physician-defined Ground Truth. Our new algorithm correctly registers without any manual interaction in 76% of the cases, the average RMS TRE over multiple target lesions throughout the liver is 8.1 mm.