CustusX

CustusX is a free, open-source research platform for image-guided intervention and surgical navigation, developed by SINTEF Medical Technology in Norway together with the national research centre MiDT at St. Olavs Hospital in Trondheim. It is meant for research groups that build and test navigation systems: it combines preoperative CT or MRI, tracked instruments, video and intraoperative ultrasound in one application. The current CustusX release is v26.08, published on 31 August 2026 for Ubuntu and Windows.

CustusX is not dental software. The developers describe its use in neurosurgery, laparoscopic and vascular surgery, interventional radiology and bronchoscopy, and they state plainly that CustusX is a research tool, “not intended for routine clinical use”, and neither FDA nor CE approved. For a dental researcher it can still import a CBCT scan, display it in 2D and 3D, threshold bone and export a surface as STL – but it has no implant planning, guided surgery or maxillofacial modules.

CustusX at a glance

What it does

• Flexible views – 2D, 3D and video views arranged in view groups; 2D planes can follow the data axes (axial, coronal, sagittal) or the tracked tool (anyplane, dual, radial).
• Data import – DICOM (8, 16 or 32 bit), MetaImage (.mhd), NIfTI and PNG images; STL, VTK and VTP surface models; MNI tag point files.
• Registration – image-to-image landmark registration and patient landmark registration with a tracked pointer; v26.08 adds a Coherent Point Drift (CPD) registration filter.
• Tracking – integrated tracking through IGSTK, or PlusToolkit via OpenIGTLink as an alternative.
• Ultrasound – video streaming, ultrasound acquisition and 3D reconstruction of tracked ultrasound sweeps.
• Filters – binary threshold, contour (marching cubes with optional smoothing and decimation), dilation, Gaussian smoothing, resampling and centerline extraction.
• Workflow steps – toolbar states for acquisition, planning, registration, navigation and postoperative analysis, each with its own saved layout.
• Export – volumes as .mhd, surface models as .vtk or STL, metrics as text, screenshots and screen videos.

How dental teams use it

Turn a CBCT scan into a bone surface model

1. Open the Import widget (Ctrl+I), add the CBCT DICOM files and keep the LPS coordinate system (used by DICOM).
2. Run the Binary Threshold filter to separate bone from soft tissue.
3. Run the Contour filter on the result; adjust the threshold while watching the preview, and enable smoothing and decimation for a lighter mesh.
4. Use the Export widget to save the surface as STL for printing or mesh editing.

Study navigation concepts on a phantom

1. Import a CT or CBCT of a skull or jaw phantom and place matching landmarks in the image.
2. Connect supported tracking hardware (IGSTK or PlusToolkit) and start tracking.
3. Perform patient landmark registration with a tracked pointer and check how the tool position is shown in the images.

Any use with patients must follow the developer’s safety requirements: only within a clinical study, only with anonymised data, only as additional information alongside a standard approved procedure.

Install and first run

• Ubuntu: the release page offers separate installers for Ubuntu 20.04, 22.04 and 24.04 and an installer script. Ubuntu is the main development platform and is tested continuously; the upcoming v26.09 drops Ubuntu 20.04.
• Windows: a pre-built Windows installer has been published since v26.08. The developers note it has not been tested as thoroughly as the Ubuntu builds; tracking on Windows uses IGSTK.
• macOS: not supported.
• Graphics: all platforms have been tested with NVIDIA GPUs; other GPUs may work.
• Known issue: tracking hardware support is not available in the open-source build on Ubuntu 24.04. If you need tracking, check the release notes before choosing the OS.
• First run: follow the built-in tutorial topics in the user documentation (volumes, image landmark registration, tracking, DICOM import). Session data is stored in a patient folder ending in .cx3.

Limitations

• Research tool only: not FDA or CE approved and not intended for routine clinical use.
• No dental or maxillofacial features – no implant libraries, nerve tracing, panoramic views or guide design.
• Navigation features need tracking hardware and technical setup; without it CustusX is mostly a viewer with filters.
• The Windows build is new and less tested; there is no macOS version.
• Documentation is written for engineers and researchers, not for dental staff.

CustusX vs alternatives

FAQ

What is CustusX?

CustusX is an open-source navigation and visualisation platform for image-guided therapy research, with a focus on intraoperative use and ultrasound imaging.

Is CustusX free?

Yes. It is released under the BSD-3-Clause licence and is free to download and use for any purpose.

Is there a CustusX download for Windows?

Yes, since v26.08 there is a pre-built Windows installer. Ubuntu remains the primary and best-tested platform.

Does CustusX run on Mac?

No. Current releases support Ubuntu and Windows only.

Can CustusX be used for dental implant navigation?

No. CustusX has no dental implant planning or navigation workflow, and it is not approved for clinical use.

Is CustusX FDA or CE approved?

No. The developers state that it is neither FDA nor CE approved and should only be used within clinical studies.

What is the latest CustusX version?

The latest stable release is v26.08 from 31 August 2026. Release notes and updates are published by SINTEF on the official project pages.

Last checked against official sources: 28 September 2026 (developer website: custusx.pages.sintef.no). Versions and licence terms change — confirm on the developer's site before deploying in a clinic.