Because Radial-Probe Endobronchial Ultrasound (RP-EBUS) can provide real-time confirmation of a suspect peripheral nodule situated outside of the airways, it is widely used during bronchoscopy for lung cancer diagnosis. RP-EBUS, however, tends to be difficult to use effectively, without some form of guidance. Previously, we had prototyped a multimodal image-guided bronchoscopy system that provides guidance during both bronchoscopic navigation and RP-EBUS localization. To use the system, the user first generates a guidance plan offline prior to the live procedure. Later, in the surgical suite, the user then employs the image-guided system to perform the desired multimodal RP-EBUS bronchoscopy, driven by the procedure plan. We now validate this system in a series of live studies. As the first set of end-to-end live system studies, we first tested the system in controlled animal studies. Through these studies, we tested the functionality and feasibility of the system prototype over the standard clinical workflow, without the usual risks associated with live patient procedures. Through these studies, we sharpened the workflow for the prototype and improved user interaction. We then tested the refined system over the standard clinical workflow in our University Hospital’s lung cancer management clinic. This study proved the potential of our system for live clinical usage by demonstrating the safety, feasibility, and functionality of our complete system for guiding RP-EBUS bronchoscopy during peripheral nodule diagnosis.
During the diagnosis of peripheral pulmonary lesions (PPLs), radial-probe endobronchial ultrasound (RP-EBUS) is often used in combination with bronchoscopy to visualize extraluminal structures and confirm lesion sites. However, due to the steep learning curve, a physician’s ability to use RP-EBUS varies greatly in practice. On another front, image-guided bronchoscopy systems are now commonly used to assist with bronchoscopy planning and guidance.1 A procedure plan is first generated from the patient’s CT scan consisting of airway routes leading to each target lesion. Next, during live bronchoscopy, the system helps navigate the bronchoscope along the preplanned airway route close to the target lesion. However, there is no direct modality linkage and guidance between RP-EBUS and the guidance system during image-guided bronchoscopy. We now propose a multimodal image-guided methodology for guiding RP-EBUS consisting of two parts: 1) a CT-based procedure planning method that enables optimal RP-EBUS invocation, localization, preview, and RP-EBUS video simulation. 2) an intra-operative guidance system tailored to RP-EBUS localization of PPLs. We present results demonstrating the proposed system.
To diagnose peripheral lung tumors, bronchoscopy is recommended for tissue sampling. Because most peripheral target regions of interest reside outside the airways, during bronchoscopy radial probe endobronchial ultrasound (RP-EBUS) is often used to provide extraluminal information and assist in locating biopsy sites. RP-EBUSguided transbronchial needle aspiration (TBNA) has demonstrated its potential over conventional TBNA to improve the diagnostic yield of peripheral pulmonary nodule biopsy. Meanwhile, image-guided bronchoscopy systems have been introduced to enable better planning and navigation. Currently, the physician has to deal with two disconnected imaging domains during live bronchoscopy; i.e., an image-guided system and RP-EBUS. The state-of-the-art image-guided bronchoscopy systems provide no guidance for RP-EBUS and biopsy targeting during live bronchoscopy, which is needed for accurate diagnosis of peripheral pulmonary nodules. To fill this gap, we expand the concept of virtual bronchoscopy (VB) in image-guided bronchoscopy systems and build a virtual RP-EBUS model to simulate the RP-EBUS probe in the computed-tomography (CT)-based virtual chest space. Results with human patient data illustrate the synchronized visualization of the virtual RP-EBUS model with the 3D chest model.
For peripheral pulmonary lesion diagnosis, surgical thoracoscopy and percutaneous needle biopsy are common invasive options, but entail significant risks; e.g., percutaneous biopsy carries a 15% pneumothorax rate and risk of other complications. The development of new bronchoscopic devices, such as radial-probe endobronchial ultrasound (RP-EBUS), however, enables far less risky lesion diagnosis. Based on recent research, an image- guided bronchoscopy system can be used to navigate the bronchoscope close to the lesion, while RP-EBUS, which provides real-time extraluminal information on local tissue and lesions, can then be used for lesion localization and biopsy site selection. Unfortunately, physician skill in using RP-EBUS varies greatly, especially for physicians not at expert centers. This results in poor biopsy yields. Also, current state-of-the-art image-guided bronchoscopy systems provide no means for guiding the use of the RP-EBUS. We describe progress toward devising a methodology that facilitates synchronization of the known chest CT-based guidance information to possible locations for invoking RP-EBUS. In particular, we describe a top-level CT-based mechanism that mimics the possible positions of the RP-EBUS probe, supplemented with an approach that simulates possible RP-EBUS views. Results with human patient data demonstrate the potential of the methodology.
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