1
|
Zhong CH, Su ZQ, Luo WZ, Rao WY, Feng JX, Tang CL, Chen Y, Chen XB, Fan MY, Li SY. Hierarchical clock-scale hand-drawn mapping as a simple method for bronchoscopic navigation in peripheral pulmonary nodule. Respir Res 2022; 23:245. [PMID: 36104691 PMCID: PMC9472376 DOI: 10.1186/s12931-022-02160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background A feasible and economical bronchoscopic navigation method in guiding peripheral pulmonary nodule biopsy is lacking. Objective To investigate the utility of hierarchical clock-scale hand-drawn mapping for bronchoscopic navigation in peripheral pulmonary nodules. Methods We developed a hierarchical clock-scale hand-drawn mapping for bronchoscopic navigation in peripheral pulmonary nodules. Patients with peripheral pulmonary nodules were recruited and assigned to two groups in this retrospective study, subjects in VBN group received conventional bronchoscopy in conjunction with virtual bronchoscopic navigation (VBN) and radial probe endobronchial ultrasound (RP-EBUS) for biopsy (VBN group), while HBN group underwent ultrathin bronchoscopy and RP-EBUS under the guidance of hand-drawn bronchoscopic navigation (HBN). The demographic characteristics, procedural time, operating cost and diagnostic yield were compared between these two groups. Results Forty-eight patients with peripheral pulmonary nodule were enrolled in HBN group, while 42 in VBN group. There were no significant differences between VBN and HBN groups in terms of age, gender, lesion size, location and radiographic type. The time of planning pathway (1.32 vs. 9.79 min, P < 0.001) and total operation (23.63 vs. 28.02 min, P = 0.002), as well as operating cost (758.31 ± 125.21 vs.1327.70 ± 116.25 USD, P < 0.001) were markedly less in HBN group, compared with those in VBN group. The pathological diagnostic efficiency of benign and malignant disease in HBN group appeared similar with those in VBN group, irrespective of the size of pulmonary lesion (larger or smaller than 20 mm). The total diagnostic yield of HBN had no marked difference from that of VBN (75.00% vs. 61.90%, P = 0.25). Conclusions Hierarchical clock-scale hand-drawn mapping for bronchoscopic navigation could serve as a feasible and economical method for guiding peripheral pulmonary nodule biopsy, providing a comparable diagnostic yield in comparison with virtual bronchoscopic navigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02160-0.
Collapse
|
2
|
Huang H, Seif MM, Ren J, Shi H, Shen X, Wang Q, Yang J, Zhang Y, Ning Y, Yang Y, Zarogoulidis P, Tsakiridis K, Hohenforst-Schmidt W, Turner JF, Michael S, Li Q, Freitag L, Fyntanidou V, Kosmidis C, Romanidis K, Oikonomou P, Sapalidis K, Bai C. Endobronchial removal of the high-risk osseous foreign bodies with evaluation and planning by virtual navigation system. Respir Med Case Rep 2019; 28:100952. [PMID: 31709141 PMCID: PMC6831871 DOI: 10.1016/j.rmcr.2019.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022] Open
Abstract
We report herein on two cases where high-risk osseous foreign bodies that incarcerated or penetrated the bronchial wall. The foreign bodies were unable to be removed via flexible bronchoscope (FB), with the foreign bodies close to the pulmonary artery and aortic artery. After preoperative evaluation and planning with the virtual bronchoscopic navigation (VBN) system, the airway foreign bodies were extracted effectively and safely using advanced therapeutic endoscopic technique by rigid bronchoscope (RB), thus avoiding the surgical thoracotomy.
Collapse
Affiliation(s)
- Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Moaad Mohamed Seif
- Department of Pulmonology, Djiboutian Military Hospital, Djibouti City, Djibouti
| | - Jie Ren
- Department of Respiration, The First People's Hospital of Xinjiang, KashgarArea, Kashgar, Xinjiang, China
| | - Hui Shi
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiaping Shen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Wang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jun Yang
- Department of Laboratory & Pathology, No. 905 Hospital, The Second Military Medical University, Shanghai, China
| | - Yuan Zhang
- Department of Ophthamology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yunye Ning
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yuguang Yang
- Department of Anesthesiology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Paul Zarogoulidis
- 3rdSurgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Corresponding author. 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.
| | - Kosmas Tsakiridis
- Thoracic Surgery Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, “Hof” Clinics, University of Erlangen, Hof, Germany
| | - J. Francis Turner
- University of Tennessee Graduate School of Medicine, Department of Medicine, Knoxville, TN, USA
| | - Simoff Michael
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, Detroit, USA
| | - Qiang Li
- The Diagnostic and Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Essen, Germany
| | - Varvara Fyntanidou
- Anesthesiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christoforos Kosmidis
- 3rdSurgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Romanidis
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Sapalidis
- 3rdSurgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
- Corresponding author. Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China.
| |
Collapse
|
3
|
Biswas A, Mehta HJ, Sriram PS. Diagnostic Yield of the Virtual Bronchoscopic Navigation System Guided Sampling of Peripheral Lung Lesions using Ultrathin Bronchoscope and Protected Bronchial Brush. Turk Thorac J 2019; 20:6-11. [PMID: 30664420 DOI: 10.5152/turkthoracj.2018.18030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The use of an ultrathin bronchoscope (UB) to diagnose peripheral pulmonary lesions is described. A virtual bronchoscopic navigation system was used to direct the ultrathin scope to the nodule. One of the constraints of this technique was the inability to confirm the target lesion position during biopsy by using a conventional linear endobronchial ultrasound probe, since the probe does not fit into a 1.2 mm working channel of this bronchoscope. The aim of the study was to review our institutional experience with the use of a UB for sampling peripheral pulmonary lesions using the transbronchial brush guided by virtual bronchoscopy. We describe a technique wherein we attempt to brush all the visible bronchial sub-segments once the bronchoscope has reached close to the nodule. MATERIALS AND METHODS In total, 52 patients underwent the procedure between 2010 and 2017. A multiplanar computed tomography (CT) scan of the chest was obtained and subsequently uploaded to the Lung Point Virtual bronchoscopy navigation software. The UB was parked close to the lesion. All visible airway branches were then brushed using a protected bronchial brush. The data were retrospectively abstracted from the electronic medical records using standardized forms. RESULTS A total of 52 lesions (40 solid, 8 part-solid, 3 cavitary, and 1 ground-glass) were sampled using a transbronchial brush (median, 2; range, 1-8). Twenty-four lesions were under 2 cm in size. The overall success rates were 67.3%. The average diameter of nodules was 2.7±1.01 cm; 65% lesions were in the outer-third of the lungs. The cancer-specific sensitivity was 72.5%. The presence of bronchus sign; location of the lesion; and the characteristics, size, and stage of cancer did not have any impact on the diagnostic yield. CONCLUSION Virtual bronchoscopy-guided ultrathin bronchoscopy with bronchial brushing is safe and has a diagnostic yield comparable to other described techniques for evaluating peripheral pulmonary nodules.
Collapse
Affiliation(s)
- Abhishek Biswas
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, USA
| | - Hiren J Mehta
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, USA
| | - P S Sriram
- Department of Pulmonary and Critical Care Medicine, Malcolm Randal VA Hospital/ North Florida-South Georgia Health System, Gainesville, USA
| |
Collapse
|
4
|
Airway Evaluation with Multidetector Computed Tomography Post-Processing Methods in Asthmatic Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 934:41-7. [PMID: 27271759 DOI: 10.1007/5584_2016_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Asthma is a chronic inflammatory obstructive airways disease. The disease occurs regardless of age and manifests with cough, attacks of breathlessness, and tightness in the chest. The pathophysiology of asthma is complex and still not fully understood. It is essential to find answers concerning the role of each part of the bronchial tree in asthma, especially the role of small bronchioles. With the development of newer generations of multidetector computed tomography (MDCT) and advanced post-processing methods it is possible to obtain more detailed images and gain insight into further aspects of asthma. MDCT post-processing methods can be divided into two-dimensional (2D) and three-dimensional (3D). In 2D projections, visualized hypodense regions correspond to the airway flow limitations. With the more advanced methods, such as multi planar reconstructions (MPR), images in different planes (axial, coronal, or sagittal) can be created. In the MPR technique only the voxels which are adjacent to each other in the predetermined plane can be extracted from the data set. Using the minimal/maximal intensity projections and shaded surface display, the volume of interest (VOI) can be extracted. High resolution CT scans can be used to create a more advanced imaging tool - the virtual bronchoscopy (VB). Using the VB makes it possible to visualize regions of obturation in the bronchi of up to the 5-8th generation. The MDCT with advanced post-processing methods is likely to assume an important role in the differential diagnosis of asthma, particularly when the diagnosis is dubious or hard to settle due to accompanying other lung diseases.
Collapse
|
5
|
McWilliams A. Does AQuIRE challenge the role of navigational bronchoscopy for peripheral pulmonary lesions? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:406. [PMID: 27867958 DOI: 10.21037/atm.2016.08.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Australia;; University of Western Australia, Perth, Australia;; Thoracic Tumour Collaborative, WA Cancer and Palliative Care Network, Perth, Australia
| |
Collapse
|
6
|
Luo M, Duan C, Qiu J, Li W, Zhu D, Cai W. Diagnostic Value of Multidetector CT and Its Multiplanar Reformation, Volume Rendering and Virtual Bronchoscopy Postprocessing Techniques for Primary Trachea and Main Bronchus Tumors. PLoS One 2015; 10:e0137329. [PMID: 26332466 PMCID: PMC4558050 DOI: 10.1371/journal.pone.0137329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the diagnostic value of multidetector CT (MDCT) and its multiplanar reformation (MPR), volume rendering (VR) and virtual bronchoscopy (VB) postprocessing techniques for primary trachea and main bronchus tumors. Methods Detection results of 31 primary trachea and main bronchus tumors with MDCT and its MPR, VR and VB postprocessing techniques, were analyzed retrospectively with regard to tumor locations, tumor morphologies, extramural invasions of tumors, longitudinal involvements of tumors, morphologies and extents of luminal stenoses, distances between main bronchus tumors and trachea carinae, and internal features of tumors. The detection results were compared with that of surgery and pathology. Results Detection results with MDCT and its MPR, VR and VB were consistent with that of surgery and pathology, included tumor locations (tracheae, n = 19; right main bronchi, n = 6; left main bronchi, n = 6), tumor morphologies (endoluminal nodes with narrow bases, n = 2; endoluminal nodes with wide bases, n = 13; both intraluminal and extraluminal masses, n = 16), extramural invasions of tumors (brokethrough only serous membrane, n = 1; 4.0 mm—56.0 mm, n = 14; no clear border with right atelectasis, n = 1), longitudinal involvements of tumors (3.0 mm, n = 1; 5.0 mm—68.0 mm, n = 29; whole right main bronchus wall and trachea carina, n = 1), morphologies of luminal stenoses (irregular, n = 26; circular, n = 3; eccentric, n = 1; conical, n = 1) and extents (mild, n = 5; moderate, n = 7; severe, n = 19), distances between main bronchus tumors and trachea carinae (16.0 mm, n = 1; invaded trachea carina, n = 1; >20.0 mm, n = 10), and internal features of tumors (fairly homogeneous densities with rather obvious enhancements, n = 26; homogeneous density with obvious enhancement, n = 1; homogeneous density without obvious enhancement, n = 1; not enough homogeneous density with obvious enhancement, n = 1; punctate calcification with obvious enhancement, n = 1; low density without obvious enhancement, n = 1). Conclusion MDCT and its MPR, VR and VB images have respective advantages and disadvantages. Their combination could complement to each other to accurately detect locations, natures (benignancy, malignancy or low malignancy), and quantities (extramural invasions, longitudinal involvements, extents of luminal stenoses, distances between main bronchus tumors and trachea carinae) of primary trachea and main bronchus tumors with crucial information for surgical treatment, are highly useful diagnostic methods for primary trachea and main bronchus tumors.
Collapse
Affiliation(s)
- Mingyue Luo
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail:
| | - Chaijie Duan
- Research Center of Biomedical Engineering, Graduate School at Shenzhen, Tsinghua University, Shenzhen, Guangdong, China
| | - Jianping Qiu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenru Li
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dongyun Zhu
- Department of Radiology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
7
|
Abstract
The recent advances in diagnostic pulmonary procedures have revolutionized the evaluation of abnormal thoracic findings including lung nodules and masses, mediastinal lymphadenopathy, and pleural diseases. Bronchoscopies with endobronchial ultrasonography and electromagnetic navigation are examples of new technology that has significantly improved the specificity and sensitivity of these procedures in diagnosis and staging of lung cancer without the need for more invasive procedures. This report describes the different diagnostic pulmonary interventions providing a description of the procedures, their indications, diagnostic yield and drawback.
Collapse
Affiliation(s)
- Nassar Al-Zubaidi
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ayman O Soubani
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
8
|
Abstract
Bronchoscopy is a commonly used minimally invasive procedure for lung-cancer staging. In standard practice, however, physicians differ greatly in their levels of performance. To address this concern, image-guided intervention (IGI) systems have been devised to improve procedure success. Current IGI bronchoscopy systems based on virtual bronchoscopic navigation (VBN), however, require involvement from the attending technician. This lessens physician control and hinders the overall acceptance of such systems. We propose a hands-free VBN system for planning and guiding bronchoscopy. The system introduces two major contributions. First, it incorporates a new procedure-planning method that automatically computes airway navigation plans conforming to the physician's bronchoscopy training and manual dexterity. Second, it incorporates a guidance strategy for bronchoscope navigation that enables user-friendly system control via a foot switch, coupled with a novel position-verification mechanism. Phantom studies verified that the system enables smooth operation under physician control, while also enabling faster navigation than an existing technician-assisted VBN system. In a clinical human study, we noted a 97% bronchoscopy navigation success rate, in line with existing VBN systems, and a mean guidance time per diagnostic site = 52 s. This represents a guidance time often nearly 3 min faster per diagnostic site than guidance times reported for other technician-assisted VBN systems. Finally, an ergonomic study further asserts the system's acceptability to the physician and long-term potential.
Collapse
|
9
|
Das K, Lababidi H, Al Dandan S, Raja S, Sakkijha H, Al Zoum M, AlDosari K, Larsson SG. Computed Tomography Virtual Bronchoscopy: Normal Variants, Pitfalls, and Spectrum of Common and Rare Pathology. Can Assoc Radiol J 2015; 66:58-70. [DOI: 10.1016/j.carj.2013.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/20/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022] Open
Abstract
A broad spectrum of pathologies that involve the laryngotracheobronchial airway and imaging plays a crucial role in evaluating these abnormalities. Computed tomography with virtual bronchoscopy has been found to be very helpful in defining the location, extent, and nature of these lesions, and is increasingly being used even in patients with contraindications for fiberoptic bronchoscopy and laryngoscopy. Ionizing radiation, associated with virtual bronchoscopy, can be minimized by using low-dose multidetector computed tomography and hybrid iterative reconstruction techniques. Furthermore, retrospectively generated virtual bronchoscopy from a routinely acquired computed tomography data set eliminates additional cost and radiation. In the future, virtual bronchoscopy assisted with advanced navigational techniques will broaden the diagnostic and therapeutic landscape. This article presents the characteristic features of common and rare laryngotracheobronchial pathologies seen with virtual bronchoscopy.
Collapse
Affiliation(s)
- K.M. Das
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hani Lababidi
- Department of Pulmonary Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sadeq Al Dandan
- Department of Pathology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Shanker Raja
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Hussam Sakkijha
- Department of Pulmonary Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine, University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - Mohammad Al Zoum
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Khalid AlDosari
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sven G. Larsson
- Department of Medical Imaging, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
10
|
Asano F, Shinagawa N, Ishida T, Tsuzuku A, Tachihara M, Kanazawa K, Yamada N, Oizumi S, Moriya H. Virtual bronchoscopic navigation improves the diagnostic yield of radial-endobronchial ultrasound for peripheral pulmonary lesions with involved bronchi on CT. Intern Med 2015; 54:1021-5. [PMID: 25948341 DOI: 10.2169/internalmedicine.54.3497] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful. METHODS The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterior-anterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated. RESULTS Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026). CONCLUSION VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.
Collapse
Affiliation(s)
- Fumihiro Asano
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
|
12
|
Gibbs JD, Graham MW, Bascom R, Cornish DC, Khare R, Higgins WE. Optimal procedure planning and guidance system for peripheral bronchoscopy. IEEE Trans Biomed Eng 2013; 61:638-57. [PMID: 24235246 DOI: 10.1109/tbme.2013.2285627] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With the development of multidetector computed-tomography (MDCT) scanners and ultrathin bronchoscopes, the use of bronchoscopy for diagnosing peripheral lung-cancer nodules is becoming a viable option. The work flow for assessing lung cancer consists of two phases: 1) 3-D MDCT analysis and 2) live bronchoscopy. Unfortunately, the yield rates for peripheral bronchoscopy have been reported to be as low as 14%, and bronchoscopy performance varies considerably between physicians. Recently, proposed image-guided systems have shown promise for assisting with peripheral bronchoscopy. Yet, MDCT-based route planning to target sites has relied on tedious error-prone techniques. In addition, route planning tends not to incorporate known anatomical, device, and procedural constraints that impact a feasible route. Finally, existing systems do not effectively integrate MDCT-derived route information into the live guidance process. We propose a system that incorporates an automatic optimal route-planning method, which integrates known route constraints. Furthermore, our system offers a natural translation of the MDCT-based route plan into the live guidance strategy via MDCT/video data fusion. An image-based study demonstrates the route-planning method's functionality. Next, we present a prospective lung-cancer patient study in which our system achieved a successful navigation rate of 91% to target sites. Furthermore, when compared to a competing commercial system, our system enabled bronchoscopy over two airways deeper into the airway-tree periphery with a sample time that was nearly 2 min shorter on average. Finally, our system's ability to almost perfectly predict the depth of a bronchoscope's navigable route in advance represents a substantial benefit of optimal route planning.
Collapse
|
13
|
Bell CS, Obstein KL, Valdastri P. Image partitioning and illumination in image-based pose detection for teleoperated flexible endoscopes. Artif Intell Med 2013; 59:185-96. [PMID: 24188575 DOI: 10.1016/j.artmed.2013.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Colorectal cancer is one of the leading causes of cancer-related deaths in the world, although it can be effectively treated if detected early. Teleoperated flexible endoscopes are an emerging technology to ease patient apprehension about the procedure, and subsequently increase compliance. Essential to teleoperation is robust feedback reflecting the change in pose (i.e., position and orientation) of the tip of the endoscope. The goal of this study is to first describe a novel image-based tracking system for teleoperated flexible endoscopes, and subsequently determine its viability in a clinical setting. The proposed approach leverages artificial neural networks (ANNs) to learn the mapping that links the optical flow between two sequential images to the change in the pose of the camera. Secondly, the study investigates for the first time how narrow band illumination (NBI) - today available in commercial gastrointestinal endoscopes - can be applied to enhance feature extraction, and quantify the effect of NBI and white light illumination (WLI), as well as their color information, on the strength of features extracted from the endoscopic camera stream. METHODS AND MATERIALS In order to provide the best features for the neural networks to learn the change in pose based on the image stream, we investigated two different imaging modalities - WLI and NBI - and we applied two different spatial partitions - lumen-centered and grid-based - to create descriptors used as input to the ANNs. An experiment was performed to compare the error of these four variations, measured in root mean square error (RMSE) from ground truth given by a robotic arm, to that of a commercial state-of-the-art magnetic tracker. The viability of this technique for a clinical setting was then tested using the four ANN variations, a magnetic tracker, and a commercial colonoscope. The trial was performed by an expert endoscopist (>2000 lifetime procedures) on a colonoscopy training model with porcine blood, and the RMSE of the ANN output was calculated with respect to the magnetic tracker readings. Using the image stream obtained from the commercial endoscope, the strength of features extracted was evaluated. RESULTS In the first experiment, the best ANNs resulted from grid-based partitioning under WLI (2.42mm RMSE) for position, and from lumen-centered partitioning under NBI (1.69° RMSE) for rotation. By comparison, the performance of the tracker was 2.49mm RMSE in position and 0.89° RMSE in rotation. The trial with the commercial endoscope indicated that lumen-centered partitioning was the best overall, while NBI outperformed WLI in terms of illumination modality. The performance of lumen-centered partitioning with NBI was 1.03±0.8mm RMSE in positional degrees of freedom (DOF), and 1.26±0.98° RMSE in rotational DOF, while with WLI, the performance was 1.56±1.15mm RMSE in positional DOF and 2.45±1.90° RMSE in rotational DOF. Finally, the features extracted under NBI were found to be twice as strong as those extracted under WLI, but no significance in feature strengths was observed between a grayscale version of the image, and the red, blue, and green color channels. CONCLUSIONS This work demonstrates that both WLI and NBI, combined with feature partitioning based on the anatomy of the colon, provide valid mechanisms for endoscopic camera pose estimation via image stream. Illumination provided by WLI and NBI produce ANNs with similar performance which are comparable to that of a state-of-the-art magnetic tracker. However, NBI produces features that are stronger than WLI, which enables more robust feature tracking, and better performance of the ANN in terms of accuracy. Thus, NBI with lumen-centered partitioning resulted the best approach among the different variations tested for vision-based pose estimation. The proposed approach takes advantage of components already available in commercial gastrointestinal endoscopes to provide accurate feedback about the motion of the tip of the endoscope. This solution may serve as an enabling technology for closed-loop control of teleoperated flexible endoscopes.
Collapse
Affiliation(s)
- Charreau S Bell
- Department of Mechanical Engineering, Vanderbilt University, 2301 Vanderbilt Place, PMB 351826, Nashville, TN 37235-1826, USA.
| | | | | |
Collapse
|
14
|
Asano F, Shinagawa N, Ishida T, Shindoh J, Anzai M, Tsuzuku A, Oizumi S, Morita S. Virtual Bronchoscopic Navigation Combined with Ultrathin Bronchoscopy. A Randomized Clinical Trial. Am J Respir Crit Care Med 2013; 188:327-33. [DOI: 10.1164/rccm.201211-2104oc] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
Merritt SA, Khare R, Bascom R, Higgins WE. Interactive CT-video registration for the continuous guidance of bronchoscopy. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1376-96. [PMID: 23508260 PMCID: PMC3911781 DOI: 10.1109/tmi.2013.2252361] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bronchoscopy is a major step in lung cancer staging. To perform bronchoscopy, the physician uses a procedure plan, derived from a patient's 3D computed-tomography (CT) chest scan, to navigate the bronchoscope through the lung airways. Unfortunately, physicians vary greatly in their ability to perform bronchoscopy. As a result, image-guided bronchoscopy systems, drawing upon the concept of CT-based virtual bronchoscopy (VB), have been proposed. These systems attempt to register the bronchoscope's live position within the chest to a CT-based virtual chest space. Recent methods, which register the bronchoscopic video to CT-based endoluminal airway renderings, show promise but do not enable continuous real-time guidance. We present a CT-video registration method inspired by computer-vision innovations in the fields of image alignment and image-based rendering. In particular, motivated by the Lucas-Kanade algorithm, we propose an inverse-compositional framework built around a gradient-based optimization procedure. We next propose an implementation of the framework suitable for image-guided bronchoscopy. Laboratory tests, involving both single frames and continuous video sequences, demonstrate the robustness and accuracy of the method. Benchmark timing tests indicate that the method can run continuously at 300 frames/s, well beyond the real-time bronchoscopic video rate of 30 frames/s. This compares extremely favorably to the ≥ 1 s/frame speeds of other methods and indicates the method's potential for real-time continuous registration. A human phantom study confirms the method's efficacy for real-time guidance in a controlled setting, and, hence, points the way toward the first interactive CT-video registration approach for image-guided bronchoscopy. Along this line, we demonstrate the method's efficacy in a complete guidance system by presenting a clinical study involving lung cancer patients.
Collapse
Affiliation(s)
| | - Rahul Khare
- Sheikh Zayed Institute at the Childrens National Medical Center, Washington, DC 20010 USA
| | - Rebecca Bascom
- Department of Medicine, Pennsylvania State Hershey Medical Center, Hershey, PA 17033 USA
| | - William E. Higgins
- Departments of Electrical Engineering, Computer Science and Engineering, and Bioengineering, Pennsylvania State University, University Park, PA 16802 USA
| |
Collapse
|
16
|
|
17
|
Graham MW, Gibbs JD, Higgins WE. Computer-based route-definition system for peripheral bronchoscopy. J Digit Imaging 2012; 25:307-17. [PMID: 22083553 DOI: 10.1007/s10278-011-9433-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Multi-detector computed tomography (MDCT) scanners produce high-resolution images of the chest. Given a patient's MDCT scan, a physician can use an image-guided intervention system to first plan and later perform bronchoscopy to diagnostic sites situated deep in the lung periphery. An accurate definition of complete routes through the airway tree leading to the diagnostic sites, however, is vital for avoiding navigation errors during image-guided bronchoscopy. We present a system for the robust definition of complete airway routes suitable for image-guided bronchoscopy. The system incorporates both automatic and semiautomatic MDCT analysis methods for this purpose. Using an intuitive graphical user interface, the user invokes automatic analysis on a patient's MDCT scan to produce a series of preliminary routes. Next, the user visually inspects each route and quickly corrects the observed route defects using the built-in semiautomatic methods. Application of the system to a human study for the planning and guidance of peripheral bronchoscopy demonstrates the efficacy of the system.
Collapse
Affiliation(s)
- Michael W Graham
- Department of Electrical Engineering, Penn State University, University Park, Pennsylvania, PA 16802, USA
| | | | | |
Collapse
|
18
|
Nam SJ, Hwangbo B. Respiratory Review of 2012: Bronchoscopic Innovations and Advances. Tuberc Respir Dis (Seoul) 2012; 73:197-203. [PMID: 23166554 PMCID: PMC3492419 DOI: 10.4046/trd.2012.73.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/10/2012] [Accepted: 09/13/2012] [Indexed: 12/04/2022] Open
Abstract
Recent advances in bronchoscopy have led to changes in clinical diagnostics and therapeutics in pulmonary medicine. In diagnostic bronchoscopy, there have also been new developments in endobronchial ultrasound technology which may be incorporated into clinical practice in the near future. Functional bronchoscopy, which evaluates information such as airway pressure, airflow, or gas exchange, suggests promising clinical advances in the near future. In therapeutic bronchoscopy, bronchoscopic volume reduction is a novel approach for the treatment of severe emphysema. In this review, seven recently published articles representing current advances in bronchoscopy are summarized and discussed.
Collapse
Affiliation(s)
- Sung-Jin Nam
- Center for Lung Cancer, National Cancer Center, Goyang, Korea
| | - Bin Hwangbo
- Center for Lung Cancer, National Cancer Center, Goyang, Korea
| |
Collapse
|