gms | German Medical Science

Introduction: 3D-navigation systems are “black boxes” that cannot be adapted specific procedures. For new developments we used our experience in the field of navigated surgery of the paranasal sinuses and the anterior skull base.

Methods: A commercial PC running under Linux and the standard libraries ITK (http://www.itk.org) and VTK (http://www.vtk.org) with an open-source digitizer (http://www.atracsys.com, Switzerland) and the Image-Guided Surgery Toolkit (http://www.igstk.org) was used.

Results: The development time for this navigation system is short; experienced C++ developers can mange the realization of the prototype in a few person-months. The use of the IGSTK libraries does allow to create regulatory body certified applications (a navigation system in this context is considered an auxiliary information-providing tool). So, it is easy to respond to clinicianś wishes. Radiologic data import is essentially done with the Oldenburg toolkit (http://www.offis.de) via network from the in-house PACS system. Up to now, the prototype has been validated on plastic phantom and cadaver heads. Visualization of data is done in the three orthogonal standard views and a 3D-reconstruction of the data, facultatively. The image-data can be zoomed and a basic measurement tool is available, too, so that the basic functionality of a surgical navigation system is available. The application accuracy found is around 1 mm in the sense of the target-registration error.

Conclusions: Software development with open-source tools is a source of future certified clinical applications; the development and documentation processes are concluded rather quickly. Prior to any patient use, internal review board approval needs to be sought, and safety and regulatory requirements need to be fulfilled.