REBOT: Robotic Endobronchial Optical Tomography

肺癌是一种诊断和治疗具有挑战性的疾病，也是全球男性和女性癌症死亡的最常见原因。五年存活率仍然很低，只有9.0%，从全球范围来看，2012年的统计数据表明，肺癌导致了159万人死亡。一个特别的困难是，大多数肺癌的诊断都是在晚期，大约75%的患者在诊断时已经是晚期疾病。因此，如果要改善预后，在早期阶段识别肺癌患者至关重要。CT筛查可以识别肺部可能的癌性结节，但随后需要活检和组织学，即在显微镜下检查组织样本，以进行诊断。提取组织样本的标准程序是经胸活检，通常是在CT图像引导下，将针插入胸壁。这提供了良好的诊断结果，但与并发症有关，特别是气胸(肺塌陷)，在15%的病例中发生。最近，技术进步允许通过支气管镜进行活检，降低了并发症的风险，并允许在常规检查期间进行该程序。然而，成功率高度依赖于操作员，对于偏远的小结节，诊断率(产率)很低。这是由于许多因素造成的，包括支气管树的复杂性、患者因呼吸(尤其是在远端支气管段)而产生的运动、糟糕的人体工程学以及大直径的支气管镜禁止进入第四代支气管段(支气管树的第四个水平)。REBOT项目的目的是开发一种机器人引导的支气管内探头，使其能够接触到肺的最深部位。它将通过支气管镜的工作通道引入，使其与当前的程序高度兼容。该探头将集成光学相干断层扫描(OCT)和荧光成像，以允许多模式可视化呼吸道的形态和细胞细节。光学相干层析成像将提供深入组织1-2毫米的3D图像，而荧光成像将提供高分辨率的表面成像。这些实时成像技术将被用来帮助将探头导航到正确的位置，以提取活检组织样本，从而增加成功诊断的机会。

Lung cancer is a challenging disease to diagnose and treat, and is the most common cause of cancer death in both men and women worldwide. Five year survival rates remain poor at 9.0%, and on a global basis, the 2012 statistics suggest that lung cancer was responsible for 1.59 million deaths. A particular difficulty is that most lung cancers are diagnosed at a late stage, with about 75% of patients having advanced disease at the time of diagnosis. Identification of patients with lung cancer at an earlier stage is therefore vital if outcomes are to be improved. CT screening can identify possible cancerous nodules in the lung, but biopsy and histology, in which a tissue sample is examined under a microscope, is then required for diagnosis. The standard procedure to extract the tissue sample is trans-thoracic biopsy, in which a needle is inserted through the chest wall, typically under CT image guidance. This provides good diagnostic results, but is associated with complications, especially pneumothoraces (collapsed lung) which occurs in 15% of cases. More recently, technical advances have allowed biopsy to be performed through a bronchoscope, reducing the risk of complications and allowing the procedure to be performed during routine examination sessions. However, success is highly operator dependent and for remote, small nodules, the diagnostic rate (the yield) is poor. This is due to a number of factors, including the complexity of the bronchial tree, patient motion due to breathing (particularly at distal segments), poor ergonomics, and the large diameter of bronchoscopes prohibiting access beyond fourth generation bronchial segments (the fourth level of 'splitting' in the bronchial tree). The purpose of the REBOT project is to develop a robot-guided endobronchial probe that will allow access to the deepest reaches of the lung. It will be introduced through a working channel of a bronchoscope, making it highly compatible with current procedures. The probe will have integrated optical coherence tomography (OCT) and fluorescence imaging to allow multi-modal visualisation of the morphological and cellular details of the airways. Optical coherence tomography will provide 3D images to a depth of 1-2 mm into the tissue, while fluorescence imaging will provide high resolution surface imaging. These real-time imaging techniques will be used to help navigate the probe to the correct location for extraction of the biopsy tissue sample, increasing the chances of a successful diagnosis.