Using optical coherence tomography to improve diagnostic and therapeutic bronchoscopy.
Flexible bronchoscopy is a common procedure that is used in both diagnostic and therapeutic settings but does not readily permit measurement of central airway dimensions. Anatomic optical coherence tomography (a OCT), a modification of conventional optical coherence tomography (OCT), is a novel light-based imaging tool with the capacity to measure the diameter and lumen area of the central airways accurately during bronchoscopy. This study describes the first clinical use of aOCT imaging in the lower airways in three individuals with common endobronchial pathologies. During bronchoscopy, a specialized fiberoptic probe was passed through the biopsy channel of a standard flexible bronchoscope to the site of airway pathology. Airway dimensions were measured from the generated cross-sectional images in three subjects, one with subglottic tracheal stenosis (subject 1), one with malignant left main bronchus (LMB) obstruction (subject 2), and another with severe tracheomalacia (subject 3). Measured dimensions included internal airway diameter, cross-sectional area, and, in subject 1, stenosis length. Tracheal stenosis dimensions, measured using aOCT imaging, correlated with chest CT scan findings and guided the choice of airway stent (subject 1). The airway beyond a malignant obstruction of the LMB, and beyond bronchoscopic view, could be imaged using aOCT, and the distal extent of obstructing tumor identified (subject 2). The severity of newly diagnosed tracheomalacia was able to be quantified using aOCT imaging (subject 3). aOCT imaging during bronchoscopy allows accurate real-time airway measurements and may assist bronchoscopic assessment.
Williamson
Jonathan P
JP
Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia. Electronic address: Jonathan.Williamson@health.wa.gov.au.
McLaughlin
Robert A
RA
Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia.
Phillips
Martin J
MJ
Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Armstrong
Julian J
JJ
Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia.
Becker
Sven
S
Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia.
Walsh
Jennifer H
JH
West Australian Sleep Disorders Research Institute, Perth, WA, Australia.
Sampson
David D
DD
Optical + Biomedical Engineering Laboratory, School of Electrical, Electronic & Computer Engineering, University of Western Australia, Perth, WA, Australia.
Hillman
David R
DR
Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Eastwood
Peter R
PR
Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
D000368:Aged; D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000601:surgery; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D014135:Tracheal Stenosis / Q000175:diagnosis* / Q000601:surgery; D055089:Tracheobronchomalacia / Q000175:diagnosis* / Q000601:surgery