Interbronchoscopist Variability in Endobronchial Path Selection

Dolina, Marina; Cornish, Duane C.; Merritt, Scott A.; Rai, Lav; Mahraj, Rickhesvar; Higgins, William E.; Bascom, Rebecca

doi:10.1378/chest.07-2540

Cited by 55 publications

(50 citation statements)

References 36 publications

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“…To this end, bronchoscopists normally estimate the 3-dimensional distribution of the bronchus by referring to 2-dimensional planar axial slices on preexamination CT, and select a bronchial path during the examination. However, this method is inaccurate [5] and not applicable for bronchi that are more peripheral than the subsegmental bronchi.…”

Section: Introductionmentioning

confidence: 99%

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

2014

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Virtual bronchoscopic navigation (VBN) is a method in which the bronchoscope is guided on the bronchial route to a peripheral lesion using virtual bronchoscopic images. In reports on VBN for peripheral pulmonary lesions searched in PubMed as of November 2013, the diagnostic yield by ultrathin bronchoscopy in combination with computed tomography and VBN was within the range of 65.4-81.6%. Using endobronchial ultrasonography with a guide sheath (EBUS-GS) and VBN, it was between 63.3 and 84.4%, and using X-ray fluoroscopy and VBN, it was between 62.5 and 78.7%. The overall diagnostic yield was 73.8% [95% confidence interval (CI) 70.9-76.8%] and that for lesions ≤2 cm was 67.4% (95% CI 63.3-71.5%). These values indicate high diagnostic rates. In randomized comparative trials, the combination of VBN with EBUS-GS improved the diagnostic yield and shortened the examination time. The diagnostic yields for lesions in the right upper lobe, those invisible on posterior-anterior radiographs and those located in the peripheral third of the lung field were improved by VBN on ultrathin bronchoscopy in combination with X-ray fluoroscopy. The usefulness of VBN was also found on meta-analysis. Taken together, VBN is a promising navigational bronchoscopy method as it requires no specific training, has a low overall complication rate of 1.0% (95% CI 0.2-1.8%) and does not directly induce or cause severe complications. To maximize the full potential of VBN and promote its use, investigation of cases in which it is useful, determination of the optimum combination of procedures, a cost/benefit analysis and advancement of the VBN system are warranted.

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Section: Introductionmentioning

confidence: 99%

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

2014

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“…Thin bronchoscopes with external diameters <3 mm have been used in clinical practice since 2004 and can be advanced to more peripheral bronchi than conventional bronchoscopes. The challenge is to identify the route to a peripheral lesion under direct vision within the bronchoscopic examination time [24]. However, it is difficult to obtain a three-dimensional (3-D) understanding of the complicated tracheobronchial tree based on axial CT images.…”

Section: Guidance Techniquesmentioning

confidence: 99%

‘Heat and Destroy’: Bronchoscopic-Guided Therapy of Peripheral Lung Lesions

2010

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Although the treatment of choice for stage I lung cancer patients is surgery, a lot of patients have a high comorbidity and are medically inoperable. Bronchoscopy, as a central technique in diagnosing lung cancer, has the potency to apply endoscopic therapy to small lung lesions in a minimally invasive way in patients with high risk for surgery. Unfortunately, bronchoscopy cannot always reach lesions in the peripheral lung, in particular the smaller lesions. Therefore, new guidance techniques like virtual bronchoscopy and electromagnetic navigation are now available and instead of using the systems as a diagnostic tool, these techniques may provide an option for therapeutic interventions to inoperable lung tumor patients. With endoscopic fiducial marker placement for robotic radiosurgery and endoluminal high-dose brachytherapy, local radiotherapy of peripheral lung tumors becomes feasible, reducing radiotherapy-induced toxicity. Radiofrequency tissue ablation through the working channel of a flexible bronchoscope may be a chance of making a diagnosis and a curative treatment in one endoscopic session. However, technical improvements of the ablation probes are currently necessary to expand the sizes of ablated areas. Even though the technologies are very attractive and pilot data are extremely encouraging, more studies establishing selection criteria and best utility are needed.

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“…Physicians, however, begin making errors in identifying airways at bronchial generation 2 (trachea=bronchial generation 1), with route planning performance deteriorating to 40% by bronchial generation 4 [10,11]. This poor performance in mental procedure planning directly impacts performance during later bronchoscopy.…”

Section: Introductionmentioning

confidence: 99%

Computer-Based Route-Definition System for Peripheral Bronchoscopy

2011

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Multi-detector computed tomography (MDCT) scanners produce high-resolution images of the chest. Given a patient's MDCT scan, a physician can use an image-guided intervention system to first plan and later perform bronchoscopy to diagnostic sites situated deep in the lung periphery. An accurate definition of complete routes through the airway tree leading to the diagnostic sites, however, is vital for avoiding navigation errors during image-guided bronchoscopy. We present a system for the robust definition of complete airway routes suitable for image-guided bronchoscopy. The system incorporates both automatic and semiautomatic MDCT analysis methods for this purpose. Using an intuitive graphical user interface, the user invokes automatic analysis on a patient's MDCT scan to produce a series of preliminary routes. Next, the user visually inspects each route and quickly corrects the observed route defects using the built-in semiautomatic methods. Application of the system to a human study for the planning and guidance of peripheral bronchoscopy demonstrates the efficacy of the system.

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Interbronchoscopist Variability in Endobronchial Path Selection

Cited by 55 publications

References 36 publications

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

Virtual Bronchoscopic Navigation for Peripheral Pulmonary Lesions

‘Heat and Destroy’: Bronchoscopic-Guided Therapy of Peripheral Lung Lesions

Computer-Based Route-Definition System for Peripheral Bronchoscopy

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