title: CustusX: an open-source research platform for image-guided therapy.
abstract: OBJECTIVE
  CustusX 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.
  
  
  METHODS
  CustusX 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.
  
  
  RESULTS
  The validation experiments show a navigation system accuracy of [Formula: see text]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.
  
  
  CONCLUSIONS
  CustusX 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.
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway. christian.askeland@sintef.no.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway. christian.askeland@sintef.no.
authors.forename: Christian
authors.initials: C
authors.lastname: Askeland
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.
authors.forename: Ole Vegard
authors.initials: OV
authors.lastname: Solberg
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.
authors.forename: Janne Beate Lervik
authors.initials: JB
authors.lastname: Bakeng
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.
authors.forename: Ingerid
authors.initials: I
authors.lastname: Reinertsen
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.
authors.forename: Geir Arne
authors.initials: GA
authors.lastname: Tangen
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.
authors.forename: Erlend Fagertun
authors.initials: EF
authors.lastname: Hofstad
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Daniel Høyer
authors.initials: DH
authors.lastname: Iversen
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Våpenstad
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Tormod
authors.initials: T
authors.lastname: Selbekk
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: Langø
authors.affiliation: Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Toril A Nagelhus
authors.initials: TA
authors.lastname: Hernes
authors.affiliation: Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Håkon
authors.initials: H
authors.lastname: Olav Leira
authors.affiliation: Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Geirmund
authors.initials: G
authors.lastname: Unsgård
authors.affiliation: Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.|Norwegian University of Science and Technology (NTNU), Trondheim, Norway.|Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: Frank
authors.initials: F
authors.lastname: Lindseth
mesh_terms: D000465:Algorithms; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods*; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Computer-assisted interventions; Image-guided therapy; Intraoperative ultrasound; Open source; Platform