Technician-free system for image-guided bronchoscopy Rahul S. Khare, - - PowerPoint PPT Presentation

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Technician-free system for image-guided bronchoscopy Rahul S. Khare, - - PowerPoint PPT Presentation

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Technician-free system for image-guided bronchoscopy Rahul S. Khare, 1 Rebecca Bascom, 2 and William E. Higgins 1 1 Penn State University Dept. of Electrical Engineering 1 and Dept. of Medicine 2 University Park and Hershey, PA USA SPIE

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SLIDE 1

Technician-free system for image-guided bronchoscopy

Rahul S. Khare,1 Rebecca Bascom,2 and William E. Higgins1 SPIE Medical Imaging 2013: Image-Guided Procedures, Robotic Interventions and Modeling Orlando, FL, 12 Feb. 2013.

1Penn State University

  • Dept. of Electrical Engineering1

and Dept. of Medicine2 University Park and Hershey, PA USA

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SLIDE 2

Lung Cancer Assessment

1. 3D MDCT image-based planning

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SLIDE 3

Lung Cancer Assessment

Drawing by Terese Winslow, “Bronchoscopy,” NCI Visuals Online, National Cancer Institute

1. 3D MDCT image-based planning 2. Follow-on diagnostic bronchoscopy

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SLIDE 4

Bronchoscopy Guidance Systems

  • “Manual” lung cancer assessment is HARD!!
  • EM-, image-, and sensor-based bronchoscopy

guidance systems mitigate difficulty, but ….

  • Need an attending technician
  • Need extra hardware
  • Unable to detect faulty maneuvers
  • Lengthy re-synchronization after adverse events

References: Helferty2007, Higgins2008, Solomon2000, Gildea2006, Schwartz2006, Wegner2007, Cornish2012, Luo2011

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SLIDE 5

Our Approach to Image-Guided Bronchoscopy

  • 1. Pre-procedure planning – Khare SPIE MI 2011
  • Compute natural bronchoscope navigation maneuvers
  • 2. Bronchoscopy navigation – Khare SPIE MI 2010 & 2012
  • Technician-free guidance
  • Enable bronchoscope position verification

via global registration

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SLIDE 6

Precompute Guidance Paths

using standard bronchoscope maneuvers

  • 1. Rotate bronchoscope to left or right
  • 2. Flex bronchoscope tip
  • 3. Advance / withdraw bronchoscope

Source: J. Respiratory diseases, 29(11), “The technique of adult flexible bronchoscopy: Part 1,” K. Y. YONEDA, B. M. MORRISSEY

Source: http://cfcenter.stanford.edu/education/Bronchoscopy.html

Advance Withdraw Rotation

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SLIDE 7

Pre-Procedure Planning

Previous angle = 0 Previous angle = +90 Previous angle = -90 Positive angle: CW rotation Negative angle: CCW rotation CW ~ 30 Go “UP” CCW ~ -150 Go “DOWN” CW ~ 30 Go “UP”

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SLIDE 8

Guidance Computer Set-up

Thumbnail Plan Tool CT-Video Guidance Tool 3D Surface Tool Foot pedal Commands

Live Video

Virtual Bronchoscope

Frozen View of Previous Site

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SLIDE 9

Guidance Strategy

  • 1. Real and virtual bronchoscopes positioned at main carina.
  • 2. Physician presses foot pedal to advance system display.

Virtual bronchoscope rotates.

  • 3. Physician mimics maneuver by moving bronchoscope.

Real and virtual bronchoscopes become synchronized.

  • 4. Physician presses foot pedal to advance system display.

System display depicts next bifurcation and freezes the previous view.

  • 5. Physician copies maneuver by moving bronchoscope.

Real and virtual bronchoscopes become synchronized.

  • 6. Physician presses foot pedal to activate targeting circles.

Physician properly positions bronchoscope and invokes global registration.

  • 7. Global registration  verifies current real bronchoscope’s position.
  • 8. If the physician makes a WRONG “off path” maneuver …
  • 9. Physician presses foot pedal  targeting circles appear.

Physician properly positions bronchoscope and invokes global registration.

  • 10. Global registration  Catches navigation error, suggests corrective action.
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SLIDE 10

1) Phantom Study Results

Phantom 1: 5 ROIs Phantom 2: 6 ROIs

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SLIDE 11

Phantom Study Results

* Indicates bronchoscope unable to reach last airway generation

  • Successful guidance to ALL ROIs
  • “success” = reach final airway
  • Bronchoscope navigation as deep as airway generation 12
  • ROIs 4, 5 for 21405.3a: penultimate airway generation reached
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SLIDE 12

Phantom Study video (earlier system version)

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SLIDE 13

2) Human Pilot Study: Results

  • 9 consented patients; 39 total ROIs
  • Bronchoscopes used: Olympus BF 1T180 (6 mm) or BF P180 (4.9 mm)
  • Physician underwent multiple training sessions during study
  • Physician previewed preplanned routes before each procedure
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SLIDE 14

Usage during a Human Study

guidance monitor foot pedal

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SLIDE 15

Human Study Results

  • 97% Success rate (38/39 ROIs)
  • Navigated as deep as airway generation 10
  • Failure occurred during first pilot case
  • System suggested a wrong maneuver (a bug!)
  • We upgraded the system after this case!
  • Tumor prevented complete approach

to 2 ROIs, but guidance succeeded

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SLIDE 16

Sample Frozen Views for a Human Study

ROI 2 for case 20349.3.65

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SLIDE 17

Human Studies: video for 20349.3.65

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Conclusion

  • Technician-free bronchoscopy guidance system
  • Relies on natural bronchoscope movements
  • Nearly perfect navigation success: phantoms, humans
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SLIDE 19

Acknowledgments

National Cancer Institute of the NIH

  • Grants #R01-CA074325 and #R01-CA151433

The Multidimensional Image Processing Lab at Penn State

  • Drs. Higgins and Bascom have an identified conflict of interest related to grant

R01-CA151433, which is under management by Penn State and has been reported to the NIH.

Conflict of Interest Statement

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SLIDE 20

Planning/Navigation Strategy

Left or right Rotate - Flex - Advance

Rotate clockwise Rotate counter- clockwise Rotate counter- clockwise Move UP Move DOWN Move DOWN

Maneuvers Device Directions “2D” Roads 3D airway tree

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SLIDE 21

Guidance Strategy: System-Level Algorithm

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SLIDE 22

Human Studies

Tumor ROIs Failure ROI