Benchmarking NousNav: quantifying the spatial accuracy and clinical performance of an affordable, open-source neuronavigation system.

Purpose: NousNav is a low-cost, open-source neuronavigation platform built to address the high costs and resource limitations that hinder access to advanced neurosurgical technologies in low-resource settings. The low-cost and accessibility of the system is made possible using consumer-grade optical tracking and open-source software packages. This study aims to assess the performance of these core enabling technologies by quantifying their spatial accuracy and comparing it to a commercial gold standard.

Methods: A series of experiments were conducted to evaluate the capabilities of the selected hardware and registration infrastructure utilized in NousNav. Each component was tested both in a simulated bench-top environment and clinically across four brain tumor resection cases.

Results: The Optitrack Duo tracker used by NousNav was found to have a mean localization error of 0.8mm (SD 0.4mm). In bench-top phantom testing, NousNav had an average target registration error of 5.0mm (SD 2.3mm) following patient registration. Clinical evaluations revealed a mean distance of 4.2mm (SD 1.5mm) between points reported by NousNav versus those obtained using a commercial neuronavigation system.

Conclusion: These experiments highlight the role of baseline camera tracking performance, tracked instrument calibration, and patient positioning on the spatial performance of NousNav. They also provide an essential benchmark assessment of the system to help inform future clinical use-cases and direct ongoing system development.