REBOT: Robotic Endobronchial Optical Tomography

肺癌是一种诊断和治疗具有挑战性的疾病，是全世界男性和女性癌症死亡的最常见原因。五年生存率仍然很低，只有9.0%，而在全球范围内，2012年的统计数据表明，肺癌导致159万人死亡。一个特别的困难是，大多数肺癌是在晚期诊断出来的，约75%的患者在诊断时病情已经发展到晚期。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筛查可以识别出肺中可能的癌性结节，但诊断需要活检和组织学，即在显微镜下检查组织样本。提取组织样本的标准程序是经胸活检，其中通常在CT图像引导下将针穿过胸壁插入。这提供了良好的诊断结果，但与并发症有关，特别是气胸（肺萎陷），发生在15%的病例中。最近，技术进步已经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活检。然而，成功与否高度依赖于手术人员，对于远处的小结节，诊断率（产出率）很低。这是由于许多因素造成的，包括支气管树的复杂性，患者因呼吸而运动（特别是在远端段），较差的人体工程学，以及支气管镜的大直径禁止进入第四代支气管段（支气管树的第四级“分裂”）。REBOT项目的目的是开发一种机器人引导的支气管内探针，使其能够进入肺的最深处。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，以实现气道形态和细胞细节的多模态可视化。光学相干断层扫描将提供1-2毫米深度的三维图像进入组织，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用于帮助引导探针到正确的位置，以提取活检组织样本，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.