This work is concerned with the three-dimensional (3-d) shape and pose reconstruction of the human rib cage from few two-dimensional (2-d) radiographs. The reconstruction method is based on a statistical shape model of the rib cage thatis adapted to the 2-d image data of a patient. An underlying optimization process minimizes a distance measure which quantifies the dissimilarities between 2-d projections of the 3-d shape model and the X-ray images and thereby esti-mates the shape model’s parameters. We propose a distance measure especially suited for the topology of the rib cage. A validation was performed on 29 sets of simulated, biplanar X-ray images.