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3D CT Assessment and Virtual Bronchoscopy Endoscopic Guidance

This study introduces the feasibility of PC-based virtual endoscopy for 3D CT assessment and live bronchoscopy, including a multimedia case study for CT-based report generation and bronchoscopic guidance.

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3D CT Assessment and Virtual Bronchoscopy Endoscopic Guidance

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  1. 3D CT Assessment for and Virtual Bronchoscopy Endoscopic Guidance William E. Higgins1,2 Anthony J. Sherbondy1 James P. Helferty1 Atilla P. Kiraly1 Geoffrey McLennan2 Eric A. Hoffman2 Janice Z Turlington1 1Penn State University University Park, PA 16802 2University of Iowa Iowa City, IA 52246 RSNA 2000 Chicago, IL 26 November 2000

  2. (1 of 32) infoRad Learning Objectives: • Introduce the feasibility of PC-based virtual endoscopy for both 3D CT assessment and live bronchoscopy. • Demonstrate the concept of a multimedia case study for CT-based report generation and bronchoscopic guidance. • Describe a method for linking 3D CT data to live bronchoscopic video.

  3. (2 of 32) Exhibit Overview: • Overview of virtual bronchoscopy and our system (Virtual Navigator) • Stage-1 CT-only Analysis: Human case • Stage-2 Bronchoscopy examples: • Human case • Phantom and animal studies

  4. (3 of 32) Input: high-resolution 3D radiologic chest image Explore: the virtual anatomy using computer Virtual Bronchoscopy (VB) • virtual copy of chest anatomy • permits unlimited “exploration” • no risk to patient

  5. (4 of 32) Existing Virtual Bronchoscopic Systems • Permit CT-only analysis • No link to follow-on live bronchoscopy • Limited quantitative path planning to interesting sites • Do not provide complete examination package • Often require expensive computers

  6. (5 of 32) Virtual Navigator Our Proposal: • Complete CT examination • Guide live bronchoscopy • Automate steps in CT assessment • Inexpensive, PC-based

  7. (6 of 32) Case Study: 3D CT assessment Guide bronchoscopy • Multimedia report • Supplemental plan • Build with Graphics/Processing Tools

  8. (7 of 32) Elements of Case Study: • Data Sources • 3D CT Image • Bronchoscopic Video • Reporting Abstractions • Snapshots • Plots • Movies • Case Notes • Measurements • Data Abstractions • Root Site • Key Sites • Paths • Tree

  9. (8 of 32) Study Manager 3D Surface Tool Virtualscope Projection Tools Graphics Tools - 1

  10. (9 of 32) Slicer Tools (MPR Views) Sliding Slab Depth Tools Oblique Cross Sections Plot Tool Graphics Tools - 2

  11. (10 of 32) Cube Tool CT-Video Live Match Tool Tube Viewer Notes Tool Graphics Tools - 3

  12. (11 of 32) Virtual Navigator using the CT Assessment Stage 1: Stage 2: Bronchoscopy Case Analysis Examine case and plan bronchoscopy Virtual CT guidance of live bronchoscopy

  13. (12 of 32) CT Assessment Stage 1: Stage 2: Bronchoscopy Examination Stages • Create new Case Study. • Compute guidance data. • Build complete Case Study. • Load Case Study. • Set up graphical tools. • Perform virtual-guided bronchoscopy.

  14. (13 of 32) • B • S • Create Case • A • Set up • B Stage 1: CT Assessment • Create new Case Study. • Build Case Study registry • Set up for computing guidance data • Automatically compute guidance data. • Build complete Case Study.

  15. (14 of 32) Determine global 3D interior detail Render airway tree with paths, traverse pathways. View structure relations within their environment. Extract paths through airways. Study interior path dynamics. Travel through virtual airway paths. Stage 1: CT Assessment

  16. (15 of 32) Example 1 Tracheomalacia CT Assessment • Patient underwent • EBCT scan (Electron Beam): • single 20-sec breath-hold • 133 contiguous slices • Reconstructed 3D CT image: • Slice = 512X512 voxels • Slice thickness =1.5mm • axial-plane [x-y] resolution = 0.586mm. • Virtual Navigator shows • Characteristics of collapse • Condition of extended bronchial pathways

  17. (16 of 32) MPR Views Indicate Global 3D position Depth-weighted Slab shows geometry Tracheomalacia Stage 1: CT Assessment Same 3D site focused on by all tools.

  18. (17 of 32) Tracheomalacia Stage 1: CT Assessment Selected 3D site (BLUE DOT) Highlighted on Five different tools at once.

  19. (18 of 32) Approaching collapse Site #20 Within tracheal collapse Site #47 Site #99 Site #99 Site #86 Leaving trachea Bottom to top view of collapse Near carina, leaving collapse Tracheomalacia Assessment Computed Virtual Path on coronal weighted-sum projection Key Site

  20. (19 of 32) Site #20 Site #47 Within tracheal collapse Approaching collapse Tracheomalacia Assessment Airway Cross Sectional Area Plot along Airway path Plot clearly shows section where blockage occurs drop in area

  21. (20 of 32) Tracheomalacia Assessment Captured Snapshots of Pathology Pathology documented by captured Depth-Slab snapshots. Extent of collapse shown in rendered Airway tree.

  22. (21 of 32) Example 2 Stent Modification CT Assessment + Bronchoscopy • Patient underwent • EBCT scan (Electron Beam): • single 20-sec breath-hold • 133 contiguous slices • Reconstructed 3D CT image: • Slice = 512X512 voxels • Slice thickness =1.5mm • axial-plane [x-y] resolution = 0.586mm. • Virtual Navigator shows • Details of existing stent • Basis for intervention analysis • (laser therapy was performed)

  23. (22 of 32) Stent visible In this and other views Stent Modification Stage 1: CT Assessment Same 3D site focused on by all tools.

  24. (23 of 32) Stent encroaching on main carina Stent Modification Stage 1: CT Assessment

  25. the use of Virtual Navigator for live bronchoscopy. We now present

  26. (24 of 32) • L • Load Case • S • Graphical Tools • P • Virtual Guidance Stage 2: Bronchoscopy • Load Case Study. • Set up graphical tools. • Perform virtual-guided bronchoscopy.

  27. (25 of 32) Virtual Guidance of Live Bronchoscopy Coronal Projection shows extracted airway tree Virtual data guides airway traversal. Video Match Tool shows a matched point between • CT rendering of airway region • (ROI rendered) • LIVE bronchoscope video • Corresponding videobronchoscopy (ROI superimposed)

  28. We now present Virtual Navigator applied to three bronchoscopy studies: Phantom Animal Human

  29. (26 of 32) Experimental set-up: physician was blind to phantom Rubber phantom Phantom Study Virtual Guidance of Live Bronchoscopy

  30. (27 of 32) Phantom Study Virtual Guidance of Live Bronchoscopy Registered virtual shot Extracted tree and paths Matched video frame with ROI

  31. (28 of 32) Phantom Study Numerical Results of Virtual Guidance Distance and time measured to match each ROI target. Distance measured from line extrapolated from the needle direction to metal bead edge. Note: • Average biopsy error: 1.98 mm • Average match time: 11.065 sec.

  32. (29 of 32) Animal Study CT-Video Matching Results Live Endoscopic video Matched video frame with ROI Registered virtual shot

  33. (30 of 32) Animal Study CT-Video Matching Results Actual site after guided dye marker placement. Planned site from CT analysis. Snapshots are misaligned to compensate for differing placement during CT scanning. Note:

  34. (31 of 32) Stage 2: Live Human Bronchoscopy

  35. (32 of 32) Bronchoscope video matched to rendered CT during live procedure. Live Bronchoscopic Video match with Rendered CT Airway

  36. (End) Acknowledgements Research supported by grants from: National Cancer Institute of the NIH (grant CA74325) National Center for Research Resources of the NIH (grant RR11800) Whitaker Foundation

  37. Thank You! (This presentation will repeat in 5 seconds.)

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