A Cyber-Physical System for Unified Diagnosis and Treatment of Lung Diseases

在这项研究中，我将开发一个用于肺部疾病诊断和治疗的网络物理系统(CPS)。我的项目的动机是三个事实：1)肺癌的治疗在早期被发现是最成功的。早期癌症的治疗提供了73%的生存机会，而在晚期，这一比例降至13%。然而，目前使用支气管镜活检早期诊断周围型肺病变的方法具有挑战性，诊断率各不相同。因此，有必要开发新的技术来可靠地诊断肺周围的癌症。2)目前，外科手术切除肺内的恶性结节(肿瘤直径3厘米)是首选的治疗方式。然而，大多数患者不适合手术治疗，因此需要其他治疗方案。一种新兴的侵入性较小的治疗选择是支气管镜下通过对肺部病变进行物理治疗(冷冻/光子消融)来消融肺癌。支气管镜消融并不广泛用于肺癌的治疗，主要是由于支气管镜的穿透深度有限和活动范围小。3)发生呼吸机相关事件的ICU患者的总住院死亡率接近30%。新的肺浸润物是一个诊断挑战，由于可用的采样方法不佳，患者经常开始进行非靶向治疗。弥漫性疾病的支气管镜检查和远端肺采样不标准化，缺乏可重复性，需要专业操作员。本研究的主要目的是使ICU支气管镜检查大众化，并开发一个使用视觉计算、EMT和外部配准的平台，使非熟练操作员能够在现场感知、采样和诊断病理。为此，我提出了一种CPS，它利用新的机电系统、控制算法和图像引导来解决支气管镜诊断和治疗肺部疾病的独特问题。CPS有可能通过两种具体方式增强当前的支气管镜技术，为早期肺癌和弥漫性肺部疾病提供统一的诊疗平台和现场鉴别诊断：1)操作增强：我将设计和开发一种由活动迷你支气管镜和用于转向的用户界面组成的机电设备。这个活动的迷你支气管镜是由一个柔性机器人制成的，它配备了内窥镜摄像头，以及用于组织分子成像/传感的光纤。它还提供了可用于癌组织消融或组织采样的工作通道。拟议的机电设备可用于两种场景：(1)重症监护病房中的自主组织采样：微型支气管镜使用控制算法导航到肺亚段并采集多个样本进行诊断；(2)半自动组织诊断/治疗：操作员使用用户界面将迷你支气管镜导航到肺的外围，对癌症组织进行表征、采样和检测，然后进行消融。我的控制算法将在灵活性、安全性和易操作性方面提供前所未有的能力。2)视觉增强：一个关键目标是开发利用新兴分子成像技术的算法，为肺部疾病的体内诊断提供成像技术。我推测，拟议的CPS将使肺部疾病的快速现场评估和成功的支气管镜检查和治疗成为可能。

In this research, I will develop a cyber-physical system (CPS) for the diagnosis and treatment of lung diseases. My project is motivated by three facts: 1) Lung cancer treatment is most successful when it is found at an early stage. Treatment of early-stage cancer offers 73% chance of survival, whereas in late-stage this is reduced to 13%. However, the current methods for early diagnosis of peripheral lung lesions using bronchoscopic biopsy are challenging with varying diagnostic yield. Thus, there is a need to develop new technologies for reliable diagnosis of cancer in the lung periphery.2) At present, surgical resection of malignant nodules (Tumours<3cm diameter) in the lung is the treatment modality of choice. However, most patients are not suitable surgical candidates, thus prompting the need for other therapeutic options. An emerging less invasive treatment option is bronchoscopic ablation of lung cancer via delivering physical therapy to lesions in the lung (cryotherapy/photonic ablation). Bronchoscopic ablation is not widely used to treat lung cancer, primarily due to the limited depth of penetration and small range of motion of the bronchoscope. 3) The overall in-hospital mortality rate for patients in ICU with ventilator associated events approaches 30%. New pulmonary infiltrates are a diagnostic challenge and due to the poor sampling methods available, patients are often initiated on non-targeted therapies. Bronchoscopy and sampling of the distal lung in diffuse diseases is not standardised and lacks repeatability and requires expert operators. The key aim of this research is to democratise ICU bronchoscopy and develop a platform using vision computing, EMT and external registration to enable non-skilled operators to sense, sample and diagnose pathology in vivo in situ.To this end, I propose a CPS that addresses the unique issues of bronchoscopic diagnosis and treatment of lung diseases using novel mechatronic systems, control algorithms, and image guidance. The CPS has the potential to deliver unified diagnosis and treatment platform for early-stage lung cancer and on-site differential diagnosis of diffuse lung diseases by enhancing the current bronchoscopic technology in two specific ways:1) Manipulation augmentation: I will design and develop a mechatronic device comprised of an active mini-bronch and a user interface for steering. The active mini-bronch is made of a flexible robot equipped with an endoscopic camera, fibre-optics for molecular imaging/sensing of tissue. It also provides a working channel that can be used for ablation of cancerous tissue or tissue sampling. The proposed mechatronic device can be used in two scenarios: (1) Autonomous tissue sampling in intensive care units: The mini-bronch uses control algorithms to navigate to lung subsegments and take multiple samples for diagnosis, (2) Semi-autonomous tissue diagnosis/treatment: the operator uses the user interface to navigate the mini-bronch to the periphery of the lung, characterise, sample and detect cancerous tissue, and then ablate . My control algorithms will provide unprecedented capabilities in terms of dexterity, safety, and ease of operation. 2) Visual augmentation: A key goal is to develop algorithms that employ emerging molecular imaging techniques to provide an imaging technology for in-vivo diagnosis of lung diseases. I postulate that the proposed CPS will enable rapid on-site evaluation of lung diseases and successful bronchoscopic detection and therapy.