Cone beam CT imaging for bronchoscopy: a technical review

Setser, Randolph M.; Chintalapani, Gouthami; Bhadra, Krish; Casal, Roberto F.

doi:10.21037/jtd-20-2382

Cited by 46 publications

(44 citation statements)

References 38 publications

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“…Verhoeven et al indicated CBCT to be a valuable addition to ENB, reporting a 35.3% increase in navigation success (12). A recent study summarized the value of CBCT imaging applied for bronchoscopy, such as instrument navigation, "tool-in-lesion" confirmation, and ablation evaluation in all phases of bronchoscopy (13). These studies suggest that CBCT has the potential to become a standard technique in this growing field.…”

Section: Discussionmentioning

confidence: 99%

Mobile 3-dimensional (3D) C-arm system-assisted transbronchial biopsy and ablation for ground-glass opacity pulmonary nodules: a case report

Chen¹,

Xie²,

Zheng³

et al. 2021

Transl Lung Cancer Res

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Identification of pulmonary ground-glass opacity (GGO) lesions during bronchoscopic procedures remains challenging, as GGOs cannot be directly visualized under 2-dimensional (2D) fluoroscopy and are often difficult to detect by radial endobronchial ultrasound. Recently, a mobile 2D/3D C-arm fluoroscopy system was developed that provides both 2D fluoroscopy and mobile 3D imaging to assess and confirm the location of the lesions and ancillary bronchoscopic tools. However, previous studies focused mainly on experience of utilizing mobile 3D C-arm system for transbronchial biopsy of solid pulmonary nodules. Here, we evaluated the feasibility of mobile 3D imaging assisted transbronchial biopsy with and without ablation of two patients with GGO nodules. The first patient underwent biopsy only, and the second patient underwent biopsy in the right upper lobe lung nodule and ablation of a left upper lobe lung nodule in one session. Procedures in both patients were successfully performed, and no significant complications have been observed intra-or post-procedurally. Our case study highlights the potential value of the mobile 3D imaging system in accurate identification of the target lung lesion, confirmation of bronchoscopic tools within the lesion, and assessment of the target lesion and surrounding tissue following bronchoscopic ablation procedure. Furthermore, a "one-stop shop" bronchoscopy workflow combining both biopsy and ablation for one or more lung lesions in one session could be made possible by utilizing a hybrid mobile 2D/3D C-arm system in the bronchoscopy suite.

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Section: Discussionmentioning

confidence: 99%

Mobile 3-dimensional (3D) C-arm system-assisted transbronchial biopsy and ablation for ground-glass opacity pulmonary nodules: a case report

Chen¹,

Xie²,

Zheng³

et al. 2021

Transl Lung Cancer Res

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“…Some mobile C-arm systems-including Cios Spin (Siemens Healthineers) and Vision RFD 3D (Ziehm Imaging, Florida, USA)-are also able to perform CBCT. Although mobile C-arms have a smaller field of view and a longer image acquisition time of ~30-60 s, they can move easily, and have a smaller footprint and more acceptable price [112].…”

Section: Cone-beam Computed Tomography (Cbct)mentioning

confidence: 99%

Advances in Diagnostic Bronchoscopy

Shen

Chen

2021

Diagnostics

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The increase in incidental discovery of pulmonary nodules has led to more urgent requirement of tissue diagnosis. The peripheral pulmonary nodules are especially challenging for clinicians. There are various modalities for diagnosis and tissue sampling of pulmonary lesions, but most of these modalities have their own limitations. This has led to the development of many advanced technical modalities, which have empowered pulmonologists to reach the periphery of the lung safely and effectively. These techniques include thin/ultrathin bronchoscopes, radial probe endobronchial ultrasound (RP-EBUS), and navigation bronchoscopy—including virtual navigation bronchoscopy (VNB) and electromagnetic navigation bronchoscopy (ENB). Recently, newer technologies—including robotic-assisted bronchoscopy (RAB), cone-beam CT (CBCT), and augmented fluoroscopy (AF)—have been introduced to aid in the navigation to peripheral pulmonary nodules. Technological advances will also enable more precise tissue sampling of smaller peripheral lung nodules for local ablative and other therapies of peripheral lung cancers in the future. However, we still need to overcome the CT-to-body divergence, among other limitations. In this review, our aim is to summarize the recent advances in diagnostic bronchoscopy technology.

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“…Fluoroscopy and cone-beam computed tomography (CBCT) may help overcome these limitations (15,16). CBCT provides intraprocedural three-dimensional imaging from which structures of interest can be extracted and overlaid on fluoroscopy: this augmented fluoroscopy provides a real-time three-dimensional roadmap guidance that has been shown to increase endobronchial biopsies' diagnostic yield when used with ENB (17,18).…”

Section: Introductionmentioning

confidence: 99%

Augmented fluoroscopy guided transbronchial pulmonary microwave ablation using a steerable sheath

Ghosn¹,

Elsakka²,

Ridouani³

et al. 2022

Transl Lung Cancer Res

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Background: Transbronchial microwave ablation (MWA) is a promising novel therapy. Despite advances in bronchoscopy and virtual navigation, real time image guidance of probe delivery is lacking, and distal maneuverability is limited. Cone-beam computed tomography (CBCT) based augmented fluoroscopy guidance using steerable sheaths may help overcome these shortcomings. The aim of this study was to evaluate feasibility and accuracy of augmented fluoroscopy guided transbronchial MWA with a steerable sheath and without a bronchoscope. Methods:In this prospective study, procedures were performed under general anesthesia. Extra-bronchial lung synthetic targets were placed percutaneously. Target and airways extracted from CBCT, with planned bronchial parking point close to the target were overlaid on live fluoroscopy. Endobronchial navigation was solely performed under augmented fluoroscopy guidance. A 6.5 Fr steerable sheath was parked in the bronchus per plan, and a flexible MWA probe was inserted coaxially then advanced through the bronchus wall towards the target. Final in-target position was confirmed by CBCT. Only one ablation of 100 W-5 min was performed per target. Animals were euthanized and pathology analysis of the lungs was performed.Results: Eighteen targets with a median largest diameter of 9 mm (interquartile range, 7-11 mm) were ablated in 9 pigs. Median needle-target center distance was 2 mm (interquartile range, 0-4 mm), and was higher for lower/middle than for upper lobes [0 mm (interquartile range, 0-4 mm) vs. 4 mm (interquartile range, 3-8 mm), P=0.04]. No severe complications or pneumothorax occurred. Two cases of rib fractures in the ablation zone resolved after medical treatment. Median longest axis of the ablation zone on post-ablation computed tomography was 38 mm (interquartile range, 30-40 mm). Histology showed coagulation necrosis of ablated tissue. Conclusions: Transbronchial MWA under augmented fluoroscopy guidance using a steerable sheath is feasible and accurate.

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Cone beam CT imaging for bronchoscopy: a technical review

Cited by 46 publications

References 38 publications

Mobile 3-dimensional (3D) C-arm system-assisted transbronchial biopsy and ablation for ground-glass opacity pulmonary nodules: a case report

Mobile 3-dimensional (3D) C-arm system-assisted transbronchial biopsy and ablation for ground-glass opacity pulmonary nodules: a case report

Advances in Diagnostic Bronchoscopy

Augmented fluoroscopy guided transbronchial pulmonary microwave ablation using a steerable sheath

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