Virtual bronchoscopy guidance system for transbronchial needle aspiration

Abstract

A system for planning transbronchial needle aspiration (TBNA) based on high-resolution chest CT is presented, comprising 2D axial, coronal or sagittal views and a 3D perspective intra-luminal view of the airways. The biopsy site can be defined interactively on the 2D views, and is displayed as 3D object across the translucent bronchial wall. Reference points can be placed on anatomical landmarks like the carina, which allows measuring 3D distances to viewpoints or to other landmarks. Orientation of the targets can be estimated based on a consistent orientation of the virtual endoscopic view. The system can be used as a pre-interventional planning tool, or simultaneously during the biopsy, in order to select the optimal needle insertion points. The system does not provide registration between the virtual and the real images, and does not require special hardware for tracking or any modifications of the bronchoscope. A phantom study comprising three bronchoscopists with different levels of experience showed a significant increase in yield compared to the traditional procedure based on axial CT images alone.

Real-time CT-video registration for continuous endoscopic guidance

“…[9][10][11] Virtual bronchoscopic guidance uses surface or volumetric rendering of the endoluminal airway-tree surfaces within the 3D MDCT image to permit exploration of the anatomy by a virtual bronchoscope. 12 These endoluminal renderings attempt to accurately recreate the imaging behavior of the real bronchoscope, with the added benefit that they allow highlighting of extraluminal features such as suspect nodules that would be invisible in the bronchoscopic video.…”