Positive Airway Pressure-Enhanced CT to Improve Virtual Bronchoscopic Navigation

Díez-Ferrer, Marta; Gil, Débora; Carreño, Elena; Padrones, Susana; Aso, Samantha; Vicens, Vanesa; Cubero, Noelia; Lisbona, Rosa Lόpez; Sanchez, Carles; Borràs, Josep M.; Rosell, Antoni

doi:10.1016/j.chest.2016.08.1109

Cited by 3 publications

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“…The third group rested for 15 min while breathing under 10 cmH 2 O PAP before the CT acquisitions. After preliminary comparison [10] between the second and third groups, we chose to use the 15-min exposure again in the fourth group but increase PAP to 14 cmH 2 O before CT acquisitions. A flowchart for the study protocol is shown in Figure 1.…”

Section: Methodsmentioning

confidence: 99%

Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation

et al. 2018

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Rationale: Virtual bronchoscopic navigation (VBN) guidance to peripheral pulmonary lesions is often limited by insufficient segmentation of the peripheral airways. Objectives: To test the effect of applying positive airway pressure (PAP) during CT acquisition to improve segmentation, particularly at end-expiration. Methods: CT acquisitions in inspiration and expiration with 4 PAP protocols were recorded prospectively and compared to baseline inspiratory acquisitions in 20 patients. The 4 protocols explored differences between devices (flow vs. turbine), exposures (within seconds vs. 15-min) and pressure levels (10 vs. 14 cmH₂O). Segmentation quality was evaluated with the number of airways and number of endpoints reached. A generalized mixed-effects model explored the estimated effect of each protocol. Measurements and Main Results: Patient characteristics and lung function did not significantly differ between protocols. Compared to baseline inspiratory acquisitions, expiratory acquisitions after 15 min of 14 cmH₂O PAP segmented 1.63-fold more airways (95% CI 1.07–2.48; p = 0.018) and reached 1.34-fold more endpoints (95% CI 1.08–1.66; p = 0.004). Inspiratory acquisitions performed immediately under 10 cmH₂O PAP reached 1.20-fold (95% CI 1.09–1.33; p < 0.001) more endpoints; after 15 min the increase was 1.14-fold (95% CI 1.05–1.24; p < 0.001). Conclusions: CT acquisitions with PAP segment more airways and reach more endpoints than baseline inspiratory acquisitions. The improvement is particularly evident at end-expiration after 15 min of 14 cmH₂O PAP. Further studies must confirm that the improvement increases diagnostic yield when using VBN to evaluate peripheral pulmonary lesions.

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Section: Methodsmentioning

confidence: 99%