PurposeCustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research.MethodsCustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency.ResultsThe validation experiments show a navigation system accuracy of 1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy.ConclusionsCustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.

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Freehand 3D ultrasound is increasingly being introduced in the clinic for diagnostics and image-assisted interventions. Various algorithms exist for combining 2D images of regular ultrasound probes to 3D volumes, being either voxel-, pixel- or function-based. Previously, the most commonly used input to 3D ultrasound reconstruction has been digitized analog video. However, recent scanners that offer access to digital image frames exist, either as processed or unprocessed data. To our knowledge, no comparison has been performed to determine which data source gives the best reconstruction quality. In the present study we compared both reconstruction algorithms and data sources using novel comparison methods for detecting potential differences in image quality of the reconstructed volumes. The ultrasound scanner used in this study was the Sonix RP from Ultrasonix Medical Corp (Richmond, Canada), a scanner that allow third party access to unprocessed and processed digital data. The ultrasound probe used was the L14-5/38 linear probe. The assessment is based on a number of image criteria: detectability of wire targets, spatial resolution, detectability of small barely visible structures, subjective tissue image quality, and volume geometry. In addition we have also performed the more "traditional" comparison of reconstructed volumes by removing a percentage of the input data. By using these evaluation methods and data from the specific scanner, the results showed that the processed video performed better than the digital scan-line data, digital video being better than analog video. Furthermore, the results showed that the choice of video source was more important than the choice of tested reconstruction algorithms.

BackgroundEndobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency.AimsTo demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans.MethodsFour patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded.ResultsPreoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered.ConclusionsElectromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation.