This book constitutes the refereed proceedings of the4th International Workshop on Biomedical Image Registration, WBIR2010, held in Lübeck, Germany, in July 2010.The 17 revised full papers and 7 revised poster papers presented werecarefully reviewed and selected for inclusion in the book. The paperscover all areas of biomedical image registration and are organized intopical sections on biomedical applications, evaluation, methods ofregistration, and model based registration.