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de Ruiter QMB, Mauda-Havakuk MM, Starost MF, Bakhutashvili I, Esparza-Trujillo JA, Brown A, Natesan H, Kveen G, Lewis AL, Wood BJ, Pritchard WF, Karanian JW. Image-Guided Transbronchial Pulmonary Cryoablation with a Flexible Cryoprobe in Swine: Performance and Radiology-Pathology Correlation. J Vasc Interv Radiol 2024; 35:1022-1030.e4. [PMID: 38599280 PMCID: PMC11194150 DOI: 10.1016/j.jvir.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To evaluate the performance of a prototype flexible transbronchial cryoprobe compared with that of percutaneous transthoracic cryoablation and to define cone-beam computed tomography (CT) imaging and pathology cryolesion features in an in vivo swine model. MATERIALS AND METHODS Transbronchial cryoablation was performed with a prototype flexible cryoprobe (3 central and 3 peripheral lung ablations in 3 swine) and compared with transthoracic cryoablation performed with a commercially available rigid cryoprobe (2 peripheral lung ablations in 1 swine). Procedural time and cryoablation success rates for endobronchial navigation and cryoneedle deployment were measured. Intraoperative cone-beam CT imaging features of cryolesions were characterized and correlated with gross pathology and hematoxylin and eosin-stained sections of the explanted cryolesions. RESULTS The flexible cryoprobe was successfully navigated and delivered to each target through a steerable guiding sheath (6/6). At 4 minutes after ablation, 5 of 6 transbronchial and 2 of 2 transthoracic cryolesions were visible on cone-beam CT. The volumes on cone-beam CT images were 55.5 cm3 (SE ± 8.0) for central transbronchial ablations (n = 2), 72.5 cm3 (SE ± 8.1) for peripheral transbronchial ablations (n = 3), and 79.5 cm3 (SE ±11.6) for peripheral transthoracic ablations (n = 2). Pneumothorax developed in 1 animal after transbronchial ablation and during ablation in the transthoracic cryoablation. Images of cryoablation zones on cone-beam CT correlated well with the matched gross pathology and histopathology sections of the cryolesions. CONCLUSIONS Transbronchial cryoablation with a flexible cryoprobe, delivered through a steerable guiding sheath, is feasible. Transbronchial cryoablation zones are imageable with cone-beam CT, with gross pathology and histopathology similar to those of transthoracic cryoablation.
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Affiliation(s)
- Quirina M B de Ruiter
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Michal M Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland; Interventional Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Matthew F Starost
- Division of Veterinary Resources, National Institutes of Health, Bethesda, Maryland
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Juan A Esparza-Trujillo
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Andrew Brown
- Boston Scientific (formerly BTG), Arden Hills, Minnesota
| | | | - Graig Kveen
- Boston Scientific (formerly BTG), Arden Hills, Minnesota
| | - Andrew L Lewis
- Boston Scientific (formerly BTG), Arden Hills, Minnesota; Alchemed Bioscience Consulting Ltd, Farnham, Surrey, United Kingdom
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland; Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - William F Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - John W Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland.
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de Baère T. Commentary: Image-Guided Transbronchial Pulmonary Cryoablation. J Vasc Interv Radiol 2024; 35:1031-1032. [PMID: 38589009 DOI: 10.1016/j.jvir.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Thierry de Baère
- Department of Interventional Radiology, University of Paris-Saclay, Unité de Formation et de Recherche Médecine Le Kremlin-Bicetre, Le Kremlin-Bicetre, France; Centre d'Investigation Clinique BIOTHERIS, Institit National de Santé et der Recherche Médiacale CIC1428, Villejuif, France.
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He X, Xiao Y, Zhang X, Zhang X, Zhang X, Wei Y, Zhang Z, Xue X, Zhang S. Low-dose CT fluoroscopy-guided interventional minimally invasive robot. Heliyon 2024; 10:e28914. [PMID: 38601523 PMCID: PMC11004810 DOI: 10.1016/j.heliyon.2024.e28914] [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: 02/06/2023] [Revised: 02/27/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background This study aimed to assess the feasibility, safety, and accuracy of a low-dose CT fluoroscopy-guided remote-controlled robotic real-time puncture procedure. Methods The study involved two control groups with Taguchi method: Group A, which underwent low-dose traditional CT-guided manual puncture (blank control), and Group B, which underwent conditional control puncture. Additionally, an experimental group, Group C, underwent CT fluoroscopy-guided remote-controlled robotic real-time puncture. In a phantom experiment, various simulated targets were punctured, while in an animal experiment, attempts were made to puncture targets in different organs of four pigs. The number of needle adjustments, puncture time, total puncture operation time, and radiation dose were analyzed to evaluate the robot system. Results Successful punctures were achieved for each target, and no complications were observed. Dates were calculated for all parameters using Taguchi method. Conclusion The low-dose CT fluoroscopy-guided puncture robot system is a safe, feasible, and equally accurate alternative to traditional manual puncture procedures.
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Affiliation(s)
- Xiaofeng He
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Yueyong Xiao
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xiao Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xiaobo Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xin Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Yingtian Wei
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Zhongliang Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Xiaodong Xue
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
| | - Shiwen Zhang
- The First Medical Center of Chinese PLA General Hospital, Department of Diagnostic Radiology, Beijing, China
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Vijayan R, Sheth N, Mekki L, Lu A, Uneri A, Sisniega A, Magaraggia J, Kleinszig G, Vogt S, Thiboutot J, Lee H, Yarmus L, Siewerdsen JH. 3D-2D image registration in the presence of soft-tissue deformation in image-guided transbronchial interventions. Phys Med Biol 2022; 68. [PMID: 36317269 DOI: 10.1088/1361-6560/ac9e3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Purpose. Target localization in pulmonary interventions (e.g. transbronchial biopsy of a lung nodule) is challenged by deformable motion and may benefit from fluoroscopic overlay of the target to provide accurate guidance. We present and evaluate a 3D-2D image registration method for fluoroscopic overlay in the presence of tissue deformation using a multi-resolution/multi-scale (MRMS) framework with an objective function that drives registration primarily by soft-tissue image gradients.Methods. The MRMS method registers 3D cone-beam CT to 2D fluoroscopy without gating of respiratory phase by coarse-to-fine resampling and global-to-local rescaling about target regions-of-interest. A variation of the gradient orientation (GO) similarity metric (denotedGO') was developed to downweight bone gradients and drive registration via soft-tissue gradients. Performance was evaluated in terms of projection distance error at isocenter (PDEiso). Phantom studies determined nominal algorithm parameters and capture range. Preclinical studies used a freshly deceased, ventilated porcine specimen to evaluate performance in the presence of real tissue deformation and a broad range of 3D-2D image mismatch.Results. Nominal algorithm parameters were identified that provided robust performance over a broad range of motion (0-20 mm), including an adaptive parameter selection technique to accommodate unknown mismatch in respiratory phase. TheGO'metric yielded median PDEiso= 1.2 mm, compared to 6.2 mm for conventionalGO.Preclinical studies with real lung deformation demonstrated median PDEiso= 1.3 mm with MRMS +GO'registration, compared to 2.2 mm with a conventional transform. Runtime was 26 s and can be reduced to 2.5 s given a prior registration within ∼5 mm as initialization.Conclusions. MRMS registration via soft-tissue gradients achieved accurate fluoroscopic overlay in the presence of deformable lung motion. By driving registration via soft-tissue image gradients, the method avoided false local minima presented by bones and was robust to a wide range of motion magnitude.
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Affiliation(s)
- R Vijayan
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - N Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - L Mekki
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Lu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | | | | | - S Vogt
- Siemens Healthineers, Erlangen, Germany
| | - J Thiboutot
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - H Lee
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - L Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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Christou AS, Amalou A, Lee H, Rivera J, Li R, Kassin MT, Varble N, Tsz Ho Tse Z, Xu S, Wood BJ. Image-Guided Robotics for Standardized and Automated Biopsy and Ablation. Semin Intervent Radiol 2021; 38:565-575. [PMID: 34853503 DOI: 10.1055/s-0041-1739164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Image-guided robotics for biopsy and ablation aims to minimize procedure times, reduce needle manipulations, radiation, and complications, and enable treatment of larger and more complex tumors, while facilitating standardization for more uniform and improved outcomes. Robotic navigation of needles enables standardized and uniform procedures which enhance reproducibility via real-time precision feedback, while avoiding radiation exposure to the operator. Robots can be integrated with computed tomography (CT), cone beam CT, magnetic resonance imaging, and ultrasound and through various techniques, including stereotaxy, table-mounted, floor-mounted, and patient-mounted robots. The history, challenges, solutions, and questions facing the field of interventional radiology (IR) and interventional oncology are reviewed, to enable responsible clinical adoption and value definition via ergonomics, workflows, business models, and outcome data. IR-integrated robotics is ready for broader adoption. The robots are coming!
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Affiliation(s)
- Anna S Christou
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Amel Amalou
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - HooWon Lee
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Jocelyne Rivera
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Rui Li
- Tandon School of Engineering, New York University, Brooklyn, New York
| | - Michael T Kassin
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Nicole Varble
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.,Philips Research North America, Cambridge, Massachusetts
| | - Zion Tsz Ho Tse
- Department of Electrical Engineering, University of York, Heslington, York, United Kingdom
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland
| | - Bradford J Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, Maryland.,Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.,National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Interventional Radiology, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
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de Ruiter QMB, Fontana JR, Pritchard WF, Mauda-Havakuk M, Bakhutashvili I, Esparza-Trujillo JA, Varble NA, Verstege M, Xu S, Seifabadi R, Browning RF, Wood BJ, Karanian JW. Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance. Transl Lung Cancer Res 2021; 10:3627-3644. [PMID: 34584862 PMCID: PMC8435394 DOI: 10.21037/tlcr-21-275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endobronchial navigation is performed in a variety of ways, none of which are meeting all the clinicians' needs required to reach diagnostic success in every patient. We sought to characterize precurved and steerable guiding sheaths (GS) in endobronchial targeting for lung biopsy using cone beam computed tomography (CBCT) based augmented fluoroscopy (AF) image guidance. METHODS Four precurved GS (EdgeTM 45, 90, 180, 180EW, Medtronic) and two steerable GS [6.5 F Destino Twist (DT), Oscor; 6 F Morph, BioCardia] were evaluated alone and in combination with an electromagnetic tracking (EM) guide and biopsy needles in three experimental phases: (I) bench model to assess GS deflection and perform biopsy simulations; (II) ex vivo swine lung comparing 2 steerable and 2 precurved GS; and (III) in vivo male swine lung to deliver a needle (n=2 swine) or to deliver a fiducial marker (n=2 swine) using 2 steerable GS. Ex vivo and in vivo image guidance was performed with either commercial or prototype AF image guidance software (Philips) based on either prior CT or procedural CBCT. Primary outcomes were GS delivery angle (θGS) and needle delivery angle (θN) in bench evaluation and needle delivery error (mm) (mean ± se) for ex vivo and in vivo studies. RESULTS The steerable DT had the largest range of GS delivery angles (θN: 0-114°) with either the 21 G or 19 G biopsy needle in the bench model. In ex vivo swine lung, needle delivery errors were 8.7±0.9 mm (precurved Edge 90), 5.4±1.9 mm (precurved Edge 180), 4.7±1.2 mm (steerable DT), and 5.6±2.4 mm (steerable Morph). In vivo, the needle delivery errors for the steerable GS were 6.0±1.0 mm (DT) and 15±7.0 mm (Morph). In vivo marker coil delivery was successful for both the steerable DT and morph GS. A case report demonstrated successful needle biopsy with the steerable DT. CONCLUSIONS Endobronchial needle delivery with AF guidance is feasible without a bronchoscope with steerable GS providing comparable or improved accuracy compared to precurved GS.
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Affiliation(s)
- Quirina M. B. de Ruiter
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Joseph R. Fontana
- Pulmonary Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - William F. Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michal Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Juan A. Esparza-Trujillo
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Nicole A. Varble
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Philips Research of North America, Cambridge, MA, USA
| | | | - Sheng Xu
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Reza Seifabadi
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | | | - Bradford J. Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Cancer Research, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - John W. Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
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Agrawal A. Interventional Pulmonology: Diagnostic and Therapeutic Advances in Bronchoscopy. Am J Ther 2021; 28:e204-e216. [PMID: 33590989 DOI: 10.1097/mjt.0000000000001344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventional pulmonology is a rapidly evolving subspecialty of pulmonary medicine that offers advanced consultative and procedural services to patients with airway diseases, pleural diseases, as well as in the diagnosis and management of patients with thoracic malignancy. AREAS OF UNCERTAINTY The institution of lung cancer screening modalities as well as the search of additional minimally invasive diagnostic and treatment modalities for lung cancer and other chronic lung diseases has led to an increased focus on the field of interventional pulmonology. Rapid advancements in the field over the last 2 decades has led to development of various new minimally invasive bronchoscopic approaches and techniques for patients with cancer as well as for patients with chronic lung diseases. DATA SOURCES A review of literature was performed using PubMed database to identify all articles published up till October 2020 relevant to the field of interventional pulmonology and bronchoscopy. The reference list of each article was searched to look for additional articles, and all relevant articles were included in the article. THERAPEUTIC ADVANCES Newer technologies are now available such navigation platforms to diagnose and possibly treat peripheral pulmonary nodules, endobronchial ultrasound in diagnosis of mediastinal and hilar adenopathy as well as cryobiopsy in the diagnosis of diffuse lung diseases. In addition, flexible and rigid bronchoscopy continues to provide new and expanding ability to manage patients with benign and malignant central airway obstruction. Interventions are also available for diseases such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and emphysema that were traditionally treated with medical management alone. CONCLUSIONS With continued high quality research and an increasing body of evidence, interventional bronchoscopy has enormous potential to provide both safe and effective options for patients with a variety of lung diseases.
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Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
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