title: Electromagnetic navigation during flexible bronchoscopy.
abstract: BACKGROUND
  Flexible bronchoscopy is routinely utilized in the diagnosis and treatment of various lung diseases. Nondiagnostic bronchoscopy leads to more invasive interventions, such as transthoracic needle aspiration, mediastinoscopy or even thoracotomy. Electromagnetic navigation is a novel technology that facilitates approaching peripheral lung lesions, which are difficult to sample by conventional means. The navigation system involves creating an electromagnetic field around the chest and localizing an endoscopic tool using a microsensor overlaid upon previously acquired CT images.
  
  
  OBJECTIVE
  To determine the practicality, accuracy and safety of real-time electromagnetic navigation, coupled with previously acquired 3D CT images, in locating artificially created peripheral lung lesions in a swine model.
  
  
  METHODS
  Peripheral lung lesions were created in four swine models by insertion of a metal tube (1 x 10 mm) via a transthoracic approach. An electromagnetic field was created by placing the animal on an electromagnetic location board. A position sensor incorporated into the distal tip of a dedicated tool was used to navigate to the various target lesions. Information gathered in real time during bronchoscopy was presented on a monitor simultaneously by displaying previously acquired CT images. Upon reaching the target lesion, biopsies were performed and the functionality and safety of the superDimension/Bronchus System was observed and documented.
  
  
  RESULTS
  The registration accuracy expressed by the fiducial target registration error, expressing both the registration quality and the stability of fiducial (registration) points, was 4.5 mm on average. No adverse effects, such as pneumothorax or internal bleeding, were encountered in any of the animals in this study.
  
  
  CONCLUSIONS
  Real-time electromagnetic positioning technology coupled with previously acquired CT images is an accurate technology added to standard bronchoscopy to assist in reaching peripheral lung lesions and performing biopsies.
authors.affiliation: Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. Schwarz@tasmc.health.gov.il
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Schwarz
authors.forename: Atul C
authors.initials: AC
authors.lastname: Mehta
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
authors.forename: Felix
authors.initials: F
authors.lastname: Herth
authors.forename: Ahuva
authors.initials: A
authors.lastname: Engel
authors.forename: Doron
authors.initials: D
authors.lastname: Besser
authors.forename: Heinrich D
authors.initials: HD
authors.lastname: Becker
mesh_terms: D000818:Animals; D001999:Bronchoscopy / Q000379:methods*; D004574:Electromagnetic Fields; D055590:Electromagnetic Phenomena; D005260:Female; D023421:Models, Animal; D025321:Surgery, Computer-Assisted; D013552:Swine