Journal: Translational Lung Cancer Research

Article Title: Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance

doi: 10.21037/tlcr-21-275

Figure Lengend Snippet: Overview of the experimental study design. Phase 1: All GS were evaluated in a bench model to assess GS deflection, alone and in combination with various biopsy needles to simulate needle deliveries in five biopsy scenarios. Phase 2: Two precurved and two steerable GS were evaluated in an ex vivo lung model using CBCT and AF image guidance to assess needle delivery error across multiple operators. Commercial AF software and prototype AF software with additional capabilities were used. Phase 3: The steerable GS were evaluated in an in vivo swine model using CBCT and prototype AF image guidance to assess the feasibility of endobronchial delivery, including transbronchial needle and fiducial marker delivery. GS, guiding sheath; AF, augmented fluoroscopy; CBCT, cone beam computed tomography.

Article Snippet: We would like to acknowledge Lucia Fonseca and William van der Sterren from Philips Healthcare for the development of the augmented fluoroscopy prototype software.

Techniques: Ex Vivo, Software, In Vivo, Marker, Computed Tomography

Journal: Translational Lung Cancer Research

Article Title: Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance

doi: 10.21037/tlcr-21-275

Figure Lengend Snippet: CT, CBCT, and AF image-guided navigation workflow with the prototype software. 1. Planning: a planning CBCT scan is acquired, or a preoperative planning CT is acquired and imported into the system. Automatic bone and airway segmentation is followed by manual segmentation of targets and automatic generation of a centerline to enhance visualization of the navigation pathway from the trachea to the target. The registered segmented airway, targets, and navigation pathways are superimposed onto real-time fluoroscopic imaging (i). In this normal animal shown, there were no lung lesions; the target is virtual. If AF planning were performed on a preoperative CT scan, image registration permits superimposition of the preoperative planning and CT on intraoperative CBCT and real-time fluoroscopy (ii). 2. Navigation and guidance: Fluoroscopic imaging at multiple C-arm angles is used to guide the bronchoscope, GS, and needle delivery. 3. Assessment: A confirmatory CBCT is acquired to assess needle delivery accuracy or to update the AF treatment planning. 4. Adjustment: Updated AF planning based on confirmatory CBCT can replace the original AF to guide repositioning of devices if required either by direct overlay of the confirmatory CBCT (iii), or by AF based on planning registered with confirmatory CBCT (iv) or AF based on planning CT registered with confirmatory CBCT (v). GS, guiding sheath; AF, augmented fluoroscopy; CBCT, cone beam computed tomography.

Article Snippet: We would like to acknowledge Lucia Fonseca and William van der Sterren from Philips Healthcare for the development of the augmented fluoroscopy prototype software.

Techniques: Software, Imaging, Computed Tomography

Journal: Translational Lung Cancer Research

Article Title: Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance

doi: 10.21037/tlcr-21-275

Figure Lengend Snippet: Ex vivo and in vivo image-guided procedural flow, navigation, and needle delivery error. (A1) Side view of the ex vivo swine lung in a vacuum container on the fluoroscopy table. (A2) Front view of the ex vivo swine lung model with a Morph guiding sheath (GS) (arrow) positioned in the bronchial airway with the intention of radiation safety: and a blue radiation-absorbing blanket that should optimally be placed over the subject body, ceiling-mounted lead screen (black star) and detector positioned to minimize air gap and radiation scatter to the operator (red star). (B-G) Use of commercially available augmented fluoroscopy (AF) software (B-D) and prototype augmented fluoroscopy (AF) software (E-G) for planning (B,E), image guidance and navigation (C,F), and assessment of GS navigation and needle delivery (TBAT) to the target (D,G). Note that the prototype software incorporated airway segmentation and planning. (H) Comparison of precurved and steerable GS needle combination (21G or TBAT) needle delivery error in the ex vivo (gel bead target) and in vivo (peripheral virtual target) swine lung models. Needle delivery error is expressed in mm (mean ± se). *, GS navigation failures that were excluded from the error analysis included: ex vivo bronchoscope (n=2) and precurved Edge 90 (n=3), and in vivo steerable Morph (n=1). AF, augmented fluoroscopy; DT, Destino twist.

Article Snippet: We would like to acknowledge Lucia Fonseca and William van der Sterren from Philips Healthcare for the development of the augmented fluoroscopy prototype software.

Techniques: Ex Vivo, In Vivo, Software, Comparison

Journal: Translational Lung Cancer Research

Article Title: Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance

doi: 10.21037/tlcr-21-275

Figure Lengend Snippet: Attempted biopsy of the central lung nodule using a bronchoscope and Edge catheter. (A) The needle is projected over the target nodule in this single fluoroscopy projection. The segmented lesion (blue) and the guidance overlay on the fluoroscopic image are shown, including the planned airway exit point (purple circle), planned needle endpoint (teal circle), and needle trajectory (purple line). (B) A second fluoroscopy projection demonstrated the needle was not in the lesion. (C) Simulation of positioning of the bronchoscope, GS, and EM locatable guide, with the tip pointing towards the lesion. (D,E) A smaller scope is used, in which AF and CBCT showed that the catheter failed to navigate to the lesion. (F) Simulation of the bronchoscope, with the GS and replacing the EM locatable guide with the biopsy needle, illustrating the failure to deliver the needle in the lesion. GS, guiding sheath; AF, augmented fluoroscopy; CBCT, cone beam computed tomography; EM, electromagnetic tracking.

Article Snippet: We would like to acknowledge Lucia Fonseca and William van der Sterren from Philips Healthcare for the development of the augmented fluoroscopy prototype software.

Techniques: Computed Tomography

Journal: Translational Lung Cancer Research

Article Title: Endovascular steerable and endobronchial precurved guiding sheaths for transbronchial needle delivery under augmented fluoroscopy and cone beam CT image guidance

doi: 10.21037/tlcr-21-275

Figure Lengend Snippet: Navigation and biopsy of the central tumor guided by a steerable sheath under AF and CBCT image guidance. (A) The operator navigates the sheath through the airways over a guidewire. The segmented lesion (blue) and the guidance overlay on the fluoroscopic image are shown, including the planned airway exit point (purple circle), planned needle endpoint (teal circle), and needle trajectory (purple line). (B) Catheter positioned with the tip at the planned airway puncture site. (C) The sheath tip is deflected by rotating the catheter handle to gain the preferred angle towards the tumor. (D) Simulation of the steerable catheter with the tip flexed and pointing toward the lesion before the introduction of a biopsy instrument. (E) Wang needle is introduced, deflecting the DT tip to a straighter angle. (F) The operator deflects the DT angle to compensate for tip deformation, achieving the desired angle for insertion of the needle into the target. (G) A CBCT confirmed the position of the needle in the target. (H) Simulation of the steerable catheter with the proximal tip deflected to point toward the lesion after the introduction of a biopsy needle, illustrating successful targeting of the lesion. DT, Destino twist; AF, augmented fluoroscopy; CBCT, cone beam computed tomography.

Article Snippet: We would like to acknowledge Lucia Fonseca and William van der Sterren from Philips Healthcare for the development of the augmented fluoroscopy prototype software.

Techniques: Computed Tomography