Virtual tools are used to manipulate aspects of a three-dimensional medical image volume. The virtual tools are geo-registered with the image volume. Presentation of the image volume is manipulated by an image processor in response to use of the virtual tools. The virtual tools may be used to facilitate analysis of the image volume. The virtual tools may include: a virtual focal point pen; a virtual 3D cursor; a virtual transport viewer; a virtual pedestal; a virtual knife; a virtual catheter; a virtual road sign; a virtual ablation tool; a virtual table; a virtual contrast tool; and virtual icons.