A virtual bronchoscopic navigation system for pulmonary peripheral lesions.

STUDY OBJECTIVES We performed ultrathin bronchoscopy for pulmonary peripheral lesions using a system that displays virtual bronchoscopy (VB) images to the lesion simultaneously with actual images and navigates the bronchoscope to the target bronchus. We then evaluated the system with regard to its usefulness and problems. DESIGN A pilot study. SETTING A tertiary teaching hospital. PATIENTS The subjects were consecutive patients with small pulmonary peripheral lesions (< or = 30 mm). INTERVENTIONS Using this system, the rotation, advancement, and retreat of VB images were possible, and the bronchus into which the bronchoscope was to be advanced was displayed. VB images were displayed along with actual images, and the ultrathin bronchoscope was advanced to the target bronchus under direct vision. Under CT and radiographic fluoroscopy, a pair of forceps was inserted into the lesion via the bronchoscope. Thin-section CT images were obtained; after confirming the advancement of the bronchoscope into the target bronchus and the arrival of the forceps at the lesion, a biopsy was performed. RESULTS Study subjects included 37 patients with 38 lesions. VB images to a median of the sixth- (third- to ninth-) order bronchi could be produced. Using this system, the ultrathin bronchoscope could be advanced into the planned route for 36 of the 38 lesions (94.7%). The system was used for a median of 2.6 min, and the median examination time was 24.9 min. The biopsy forceps could be advanced to the lesion in 33 of the 38 lesions (86.8%), and diagnosis was possible for 31 lesions (81.6%). CONCLUSIONS This navigation system is useful for ultrathin bronchoscopy for pulmonary peripheral lesions.

[1]  H. Feußner,et al.  Electromagnetic catheter navigation during bronchoscopy: validation of a novel method by conventional fluoroscopy. , 2005, Chest.

[2]  Yoichiro Ishihara,et al.  Ultrathin bronchoscopic barium marking with virtual bronchoscopic navigation for fluoroscopy-assisted thoracoscopic surgery. , 2004, Chest.

[3]  H. Dienes,et al.  The impact of cytology on the bronchoscopic diagnosis of lung cancer , 2004 .

[4]  J. Verschakelen,et al.  Multidetector CT-generated virtual bronchoscopy: an illustrated review of the potential clinical indications , 2004, European Respiratory Journal.

[5]  Koichi Yamazaki,et al.  CT-guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation. , 2004, Chest.

[6]  F. Herth,et al.  Electromagnetic Navigation during Flexible Bronchoscopy , 2003, Respiration.

[7]  F. Asano,et al.  Virtual Bronchoscopy in Navigation of an Ultrathin Bronchoscope , 2002 .

[8]  Jun Sugiyama,et al.  Tracking of a bronchoscope using epipolar geometry analysis and intensity-based image registration of real and virtual endoscopic images , 2002, Medical Image Anal..

[9]  Yoichiro Ishihara,et al.  Transbronchial Diagnosis of A Pulmonary Peripheral Small Lesion Using an Ultrathin Bronchoscope with Virtual Bronchoscopic Navigation , 2002 .

[10]  K D Hopper,et al.  Transbronchial biopsy with virtual CT bronchoscopy and nodal highlighting. , 2001, Radiology.

[11]  H. Colt,et al.  Virtual reality bronchoscopy simulation: a revolution in procedural training. , 2001, Chest.

[12]  W. Baaklini,et al.  Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. , 2000, Chest.

[13]  Y Itzchak,et al.  Virtual bronchoscopy in children: early clinical experience. , 1998, AJR. American journal of roentgenology.

[14]  H. Moriya,et al.  Interactive Virtual Bronchoscopy as a Guide for Transbronchial Biopsy in Two Cases , 1998 .

[15]  A J Aschoff,et al.  Comparison of real-time virtual and fiberoptic bronchoscopy in patients with bronchial carcinoma: opportunities and limitations. , 1997, AJR. American journal of roentgenology.

[16]  H. Ohmatsu,et al.  Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. , 1996, Radiology.

[17]  V Chechani,et al.  Bronchoscopic diagnosis of solitary pulmonary nodules and lung masses in the absence of endobronchial abnormality. , 1996, Chest.

[18]  R. Lai,et al.  Diagnostic value of transbronchial lung biopsy under fluoroscopic guidance in solitary pulmonary nodule in an endemic area of tuberculosis. , 1996, Respiratory medicine.

[19]  R H Choplin,et al.  Virtual Bronchoscopy: Relationships of Virtual Reality Endobronchial Simulations to Actual Bronchoscopic Findings , 1996 .

[20]  K. Torrington,et al.  The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule. , 1993, Chest.

[21]  A. Steinbach,et al.  The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule. , 1993, Chest.

[22]  M. Gaeta,et al.  Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy. , 1991, AJR. American journal of roentgenology.

[23]  N Yanase,et al.  Diagnosis of peripheral lung cancer in cases of tumors 2 cm or less in size. , 1989, Chest.

[24]  D. Naidich,et al.  Solitary Pulmonary Nodules: CT-Bronchoscopic Correlation , 1988 .

[25]  O. Kawanami,et al.  A new bronchofiberscope for the study of diseases of very peripheral airways. , 1984, Chest.