Augmented reality 3D navigation system for percutaneous CT-guided pulmonary ground-glass opacity biopsies: a comparison with the standard CT-guided technique

Abstract

Background: Augmented reality navigation system for percutaneous computed tomography (CT)-guided pulmonary biopsies has recently been introduced. There are no studies in literature about its use for ground glass lesions biopsies. The aim of this study is to evaluate the effectiveness of an augmented reality infrared navigation system performance on CT-guided percutaneous lung ground glass opacity (GGO) biopsy compared to a standard CT-guided technique.Methods: A total of 80 patients with lung GGO who underwent to a percutaneous CT-guided lung biopsy with an augmented reality infrared navigation system were retrospectively enrolled in the study. Comparison was performed with a group of 80 patients who underwent to lung biopsy with the standard CT-guided technique. Evaluation of maximum lesion diameter (MLD), distance between lesion and pleural surface (DPS), distance travelled by the needle (DTP), procedural time, validity of histological sample, procedural complications and the radiation dose to the patient's chest were recorded for each patient of both groups. In addition, each group was divided into two subgroups based on lesion size, according to a cut-off of 1.5 cm (<1.5 cm; ≥1.5 cm).Results: Augmented reality navigation system showed a significant reduction in procedural time, radiation dose administrated to patients and complications rate compared to a standard CT-guided technique.Technical success was achieved in the 100% of cases in both groups, but the diagnostical success was higher in the group where patients underwent to lung biopsies with the use of navigation system. We also found that using an augmented reality navigation system increases the diagnostical success rate for lesion <1.5 cm.MLD, DPS and DTP did not differ significantly between the two groups of patients. Conclusions:The use of an augmented reality navigation system for percutaneous CT-guided pulmonary GGO biopsies has demonstrated a lower incidence of post-procedural complications, a significantly reduction of the radiation dose administered to patients and a higher diagnostical success rate.

Small (≤ 20 mm) ground-glass opacity pulmonary lesions: which factors influence the diagnostic accuracy of CT-guided percutaneous core needle biopsy?

“…Recently, an augmented reality navigation system has been introduced for percutaneous CT-guided pulmonary GGO biopsies. Faiella et al reported that this system can increase the diagnostic success rate for GGO lesions < 1.5 cm [15].…”

Imaging in interventional oncology, the better you see, the better you treat

“…75 Touchless interaction is another AI function which has been examined, it enables the physician to give commands while under sterile conditions, such as activating lights, switching on and off components of medical devices, or even using hand and arm gestures to browse through sets of medical images without touch. 76,77 Lastly, augmented reality (AR) and virtual reality (VR) could assist during IO procedures. While VR is mostly studied for teaching purposes, AR is experimented with in clinical practice for assistance during liver ablation and pulmonary biopsies.…”

“…[78][79][80] Specifically for pulmonary ground glass opacities, AR-assisted biopsies showed higher diagnostic accuracy for nodules <1.5 cm, a lower incidence in complications and a significant reduction of the administered radiation dose, compared to standard biopsies. 77 For patient classification and outcome prediction, studies frequently combine AI with radiomics. Radiomics is the field wherein medical images are converted into quantitative data that can be analysed using AI methods to determine the relationship between medical images and clinical outcomes.…”

“…This technology has led to a real‐time tracking model of the catheter tip during catheterization procedures, which enables roadmapping of the vasculature without a contrast agent 75 . Touchless interaction is another AI function which has been examined, it enables the physician to give commands while under sterile conditions, such as activating lights, switching on and off components of medical devices, or even using hand and arm gestures to browse through sets of medical images without touch 76,77 . Lastly, augmented reality (AR) and virtual reality (VR) could assist during IO procedures.…”

Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures

“…The main concern of CT guidance is the radiation dose to the interventional radiologist and the patients [ 70 ] even if some studies reported values in line with recommended dose limits for occupational radiation exposure [ 71 ]. To reduce the time needed for placing the probe/needle and therefore the radiation dose, some navigation systems have been developed to assist lung biopsies and thermal ablation therapies, and studies demonstrated that CT assisted with stereotactic navigation reduces the time for ablation probe placement, the number of needle adjustments, skin punctures, and fluoroscopy time [ 72 , 73 ]. The disadvantages of CT-guided procedures are the lack of tumor visibility on unenhanced images or, in the case of contrast media administration, the short contrast-enhancement timeframe [ 74 , 75 ].…”