Optimal procedure planning and guidance system for peripheral bronchoscopy.
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.
Jason D
JD
Gibbs
Michael W
MW
Graham
Rebecca
R
Bascom
Duane C
DC
Cornish
Rahul
R
Khare
William E
WE
Higgins
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014741:Video Recording; D055815:Young Adult