Highlights Implementation process of Electronic Health Records (EHRs) is critical for success. Vast literature available on EHR implementations in different settings and contexts. Organizational, Human and Technological factors influence success across settings. Dynamic interaction of the identified factors trigger success. Consideration of the specific healthcare context and end-users is important.

Peripheral lung nodules remain challenging for accurate localization and diagnosis. Once identified, there are many strategies for diagnosis with heterogeneous risk benefit analysis. Traditional strategies such as conventional bronchoscopy have poor performance in locating and acquiring the required tissue. Similarly, while computerized-assisted transthoracic needle biopsy is currently the favored diagnostic procedure, it is associated with complications such as pneumothorax and hemorrhage. Video-assisted thoracoscopic and open surgical biopsies are invasive, require general anesthesia and are therefore not a first-line approach. New techniques such as ultrathin bronchoscopy and image-based guidance technologies are evolving to improve the diagnosis of peripheral lung lesions. Virtual bronchoscopy and electromagnetic navigation systems are novel technologies based on assisted-computerized tomography images that guide the bronchoscopist toward the target peripheral lesion. This article provides a comprehensive review of these emerging technologies.

Laparoscopic colectomy is the gold standard in the treatment of malignant tumours arising in the mucosa of the colon wall. The procedure is performed under general endotracheal anaesthesia and involves establishing a pneumoperitoneum with the patient in the Trendelenburg position. However this position can cause anaesthetic difficulties due to excess blood flow to the head and neck, increased pressure on the diaphragm and increased venous pressure. In the absence of steep head-down positioning, the bowels fall or "spill" into the operating field, obstructing the surgical space. The primary goal of this work is to design an atraumatic laparoscopic retractor to minimise the Trendelenburg position whilst effectively retracting the bowels from the operating field. This work details the design, evaluation and optimisation of a novel, hand held, inflatable, laparoscopic retractor, through physical experimentation, computer simulation, and pre-clinical animal investigation. The optimised design for the inflatable retractor performs in line with simulated expectations, and was successfully tested for safety and technical feasibility in vivo in a porcine model, where the bowels were effectively removed from the operating space whilst the model remained in the supine position. These initial results represent a promising approach for the mitigation of the Trendelenburg position, whilst effectively retracting the bowels during laparoscopic colectomy, using this atraumatic, inflatable retractor.

IntroductionIn the era of lung cancer screening, tissue acquisition of peripheral lung lesions remains a challenge. We have developed a 3D electromagnetic navigation platform with airway segmentation and virtual bronchoscopy using a open source 3D slicer environment.MethodsThe open source visualisation software (3D Slicer ) created a detailed airway segmentation and virtual bronchoscopy model from acquired CT images. A magnetic field emitter board provides tracking of a semiautomatic locatable sensor probe (SALP) in the working channel of the bronchoscopewith always-on tip tracked sensor and can be steered both manually and automaticaly with joy stick, for accurate localization of peripheral lung lesion.An extensive ex-vivo evaluation was performed in a breathing lung model that was developed using inflatable plasticized pig lungs in a negative-pressure Following this, in-vivo real time navigation in a live porcine model using a selection of novel radioopaque fiducials placed endobronchially into distal airways.ResultsAfter completion of a selection of experiments using the breathing pig lung model, fiducials were placed endobronchially in our live porcine model. Thereafter, CT images were used to create a virtual airway 3D segmentation model. After multiplaner re-construction, land mark based registration was performed to align the CT and anaesthetised porcine. Manual and automatic navigation with the bronchoscope containing the SALP was performed. The average navigation distance covered was 85.3 mm. The navigational system accurately determined 84% of the navigation points within the airways.ConclusionOur navigational platform is inexpensive and open source and is the first to utilise SALP. In our model, there is good agreement between the position of the sensor probe during bronchoscopic navigation and as visualised in virtual bronchoscopy. Further work is being carried out to improve registration and accuracy of the navigational system before a pilot study in patients with peripheral lung nodules.

This paper describes a novel method of controlling an endoscopic catheter by using an automated catheter tensioning system with the objective of providing clinicians with improved manipulation capabilities within the patient. Catheters are used in many clinical procedures to provide access to the cardiopulmonary system. Control of such catheters is performed manually by the clinicians using a handle, typically actuating a single or opposing set of pull wires. Such catheters are generally actuated in a single plane, requiring the clinician to rotate the catheter handle to navigate the system. The automation system described here allows closed-loop control of a custom bronchial catheter in tandem with an electromagnetic tracking of the catheter tip and image guidance by using a 3D Slicer. An electromechanical drive train applies tension to four pull wires to steer the catheter tip, with the applied force constantly monitored through force sensing load cells. The applied tension is controlled through a PC connected joystick. An electromagnetic sensor embedded in the catheter tip enables constant real-time position tracking, whereas a working channel provides a route for endoscopic instruments. The system is demonstrated and tested in both a breathing lung model and a preclinical animal study. Navigation to predefined targets in the subject's airways by using the joystick while using virtual image guidance and electromagnetic tracking was demonstrated. Average targeting times were 29 and 10 s, respectively, for the breathing lung and live animal studies. This paper presents the first reported remote controlled bronchial working channel catheter utilizing electromagnetic tracking and has many implications for future development in endoscopic and catheter-based procedures.