Accurate staging of the central-chest lymph nodes is a major step in the management of lung-cancer patients. For this purpose, the physician uses videobronchoscopy to navigate through the airways and convex-probe endobronchial ultrasound (CP-EBUS) to localize extraluminal lymph nodes. Unfortunately, CP-EBUS proves to be difficult for many physicians. In this paper, we present a complete optimal multimodal planning and guidance system for image-guided CP-EBUS bronchoscopy. The system accepts a patient's 3D chest CT scan and an optional whole-body PET/CT study as inputs. System work flow proceeds in two stages: 1) optimal procedure planning and 2) multimodal image-guided bronchoscopy. Optimal procedure planning entails CT-based computation of guidance routes that enable maximal feasible tissue sampling (depth-of-sample) of selected lymph nodes. Multimodal image-guided bronchoscopy next occurs in the operating room. The guidance process draws upon a CT-based virtual multimodal bronchoscope that gives virtual views of videobronchoscopy and CP-EBUS, similar to those provided by a "real" linear integrated CP-EBUS bronchoscope. The system provides CT/PET-based graphical views along the guidance route toward a lymph node, per the two-stage process of videobronchoscopic navigation and CP-EBUS localization. The guidance views depict the depth-of-sample information dynamically to enable visualization of optimal tissue-biopsy sites. The localization process features a novel registration be- tween the virtual CP-EBUS views and live CP-EBUS views to enable synchronization. A lung-cancer patient pilot study demonstrated the feasibility, safety, and efficacy of the system. Procedure planning effectively derived optimal tissue-biopsy sites and also indicated sites where biopsy may not be safe, within preset constraints. During live bronchoscopy, we performed successful guidance to all selected lymph nodes.
William E. Higgins, Xiaonan Zang, Ronnarit Cheirsilp, Patrick D. Byrnes, Trevor K. Kuhlengel, Jennifer Toth, and Rebecca Bascom, "Optimal multimodal virtual bronchoscopy for convex-probe endobronchial ultrasound," Proc. SPIE 10576, Medical Imaging 2018: Image-Guided Procedures, Robotic Interventions, and Modeling, 1057618 (Presented at SPIE Medical Imaging: February 15, 2018; Published: 13 March 2018); https://doi.org/10.1117/12.2292099.
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