Pulmonologist evaluation on new CT visualization for guidance to lung lesions during bronchoscopy

Abstract

Objective: Endoluminal visualization in virtual and video bronchoscopy lacks information about the surrounding structures, and the traditional 2 D axial, coronal and sagittal CT views can be difficult to interpret. To address this challenge, we previously introduced a novel visualization technique, Anchored to Centerline Curved Surface, for navigated bronchoscopy. The current study compares the ACCuSurf to the standard ACS CT views as planning and guiding tools in a phantom study.

Material and methods: Bronchoscope operators navigated in physical phantom guided by virtual realistic image data constructed by fusion of CT dataset of phantom and anonymized patient CT data. We marked four different target positions within the virtual image data and gave 12 pulmonologists the task to navigate, with either ACCuSurf or ACS as guidance, to the corresponding targets in the physical phantom.

Results: Using ACCuSurf reduced the planning time and increased the grade of successful navigation significantly compared to ACS.

Conclusion: The phantom setup with virtual patient image data proved realistic according to the pulmonologists. ACCuSurf proved superior to ACS regarding planning time and navigation success grading. Improvements on visualisation or display techniques may consequently improve both planning and navigated bronchoscopy and thus contribute to more precise lung diagnostics.

Keywords:

• Navigated bronchoscopy
• virtual bronchoscopy
• ACCuSurf visualization
• lung diagnostics
• image guided intervention

Acknowledgements

We wish to extend our thanks to Ole Vegard Solberg, Janne Beate Lervik Bakeng, Jon Eiesland and Christian Askeland in SINTEF, for indispensable help developing and using the CustusX (www.custusx.org) open source software platform.

Declaration of interest

The authors declare that they have no conflict of interest related to the work in this study.

Additional information

Funding

This study is part of a PhD research funded by Norwegian University of Science and Technology (NTNU), Dept. Circulation and Medical Imaging, Faculty of Medicine, and the ISB fund at the Faculty of Medicine, NTNU. In addition, some authors have received funding from EEA Financial Mechanism 2009–2014 under the project [EEA-JRP-RO-NO-2013–1-0123] - Navigation System For Confocal Laser Endomicroscopy To Improve Optical Biopsy Of Peripheral Lesions In The Lungs (NaviCAD), contract no. [3SEE/30.06.2014]. The work was also funded by Liaison Committee between the Central Norway Regional Health Authority (RHA) and NTNU (Samarbeidsorganet) and the local Cancer Foundation, Felles Forskningsutvalg (FFU) and Felles Utdanningsutvalg (FUU) at Trondheim University Hospital. Furthermore, the research was funded by SINTEF and the Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy (St. Olavs hospital, NTNU, SINTEF), a service appointed by the Norwegian Ministry of Health and Care Services.