Using the CustusX toolkit to create an image guided bronchoscopy application: Fraxinus.

Janne Beate Lervik Bakeng,Ole Vegard Solberg,Tore Amundsen,Håkon Olav Leira,Geir Arne Tangen,Tormod Selbekk,Ingerid Reinertsen,Thomas Langø,Erlend Fagertun Hofstad,Jon Eiesland,Ron Kikinis

doi:10.1371/journal.pone.0211772

Abstract

PurposeThe aim of this paper is to show how a specialized planning and guidance application called Fraxinus, can be built on top of the CustusX platform (www.custusx.org), which is an open source image-guided intervention software platform. Fraxinus has been customized to meet the clinical needs in navigated bronchoscopy.MethodsThe application requirements for Fraxinus were defined in close collaboration between research scientists, software developers and clinicians (pulmonologists), and built on top of CustusX. Its superbuild system downloads specific versions of the required libraries and builds them for the application in question, including the selected plugins. New functionality is easily added through the plugin framework. The build process enables the creation of specialized applications, adding additional documentation and custom configurations. The toolkit’s libraries offer building blocks for image-guided applications. An iterative development process was applied, where the clinicians would test and provide feedback during the entire process.ResultsFraxinus has been developed and is released as an open source planning and guidance application built on top of CustusX. It is highly specialized for bronchoscopy. The proposed workflow is adapted to the different steps in this procedure. The user interface of CustusX has been modified to enhance information, quality assurance and user friendliness with the intention to increase the overall yield for the patient. As the workflow of the procedure is relatively constant, some actions are predicted and automatically performed by the application, according to the requirements from the clinicians.ConclusionsThe CustusX platform facilitates development of new and specialized applications. The toolkit supports the process and makes important extension and injection points available for customization.

Highlights

Bronchoscopy is the endobronchial procedure for inspection and diagnostic sampling in the airways, e.g. to diagnose lung cancer
Navigating the flexible video bronchoscope in the lungs is difficult due to the numerous divisions in the tree structure of the airways. Another challenge is the lack of direct visibility of smaller peripheral lesions located outside the airways
The diagnostic success rate for bronchoscopically non-visible tumors is as low as 15% compared to 80% for visible tumors, dependent on tumor size, the doctors experience and the method used for sampling [1,2,3]

Summary

Introduction

Bronchoscopy is the endobronchial procedure for inspection and diagnostic sampling in the airways, e.g. to diagnose lung cancer. Navigating the flexible video bronchoscope in the lungs is difficult due to the numerous divisions in the tree structure of the airways. Another challenge is the lack of direct visibility of smaller peripheral lesions located outside the airways. This makes it difficult to hit the target for the diagnostic sampling using biopsy or fine needle aspiration. All the commercially available systems are associated with costs related to purchase and use (consumables), which both can be considerable. This limits the widespread use of these systems in clinics. A more detailed description of the existing systems for navigated bronchoscopy, both commercial and research, are presented by Reynisson et al [4]

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