Computer Assisted Ultrathin Brochoscopy

描述（由申请人提供）：本提议的成像系统应用开发行业-学术合作伙伴关系的目的是开发计算机辅助支气管镜检查（CAUB）活检小外周肺结节的新方法。这些传统上难以使用标准的柔性支气管镜进行诊断。我们的结论是，最近的技术发展，包括：支气管镜的引进，多排CT扫描仪的广泛使用，能够产生近各向同性成像的整个肺;以及新开发的先进图像处理算法，包括用于分割和分割气道和血管以及虚拟内窥镜的复杂方法，组合具有改变用于诊断肺结节的当前临床算法的潜力。虽然迄今为止，人们的注意力几乎完全集中在使用虚拟支气管镜检查（VB）仅评价中央气道，但我们认为，需要一种更稳健的方法来识别外周气道，以扩大图像引导支气管镜检查的范围。本申请的核心是开发用于获得导致小外周肺结节的虚拟内窥镜路径的自动化方法，包括在即使使用高分辨率近各向同性CT图像也无法识别病变附近的支气管的情况下使用肺动脉作为外周支气管位置的替代标记。然后，这些自动化技术可以与超薄支气管镜检查相结合，从而对以前被认为无法通过常规柔性支气管镜检查进行的肺结节进行常规诊断。具体目标1是创建从中央气道到小型计算机生成的外周肺结节的自动虚拟内窥镜路线图，以评估自动路径规划和气道/动脉对应的可行性。具体目标2将解决这些技术在试点项目中的潜在临床应用。预计这些结果将使支气管镜检查成为评估外周肺结节的首选方法，从而改变目前的临床模式。

DESCRIPTION (provided by applicant): The purpose of this proposed Industry-Academic Partnerships for Development of Imaging Systems Application is to develop novel approaches for computer assisted ultrathin bronchoscopy (CAUB) for biopsying small peripheral lung nodules. These traditionally have been difficult to diagnose using standard flexible bronchoscopes. We conclude that recent technical developments, including: the introduction of ultrathin bronchoscopes; widespread availability of multidetector CT scanners capable of generating near isotropic imaging of the entire lung; and newly developed advanced image processing algorithms, including sophisticated methods for segmenting and skeletonizing airways and vessels as well as virtual endoscopy, combined have the potential to alter current clinical algorithms for diagnosing lung nodules. While to date attention has almost exclusively focused on the use of virtual bronchoscopy (VB) to evaluate only the central airways, in our opinion a more robust approach to identifying peripheral airways is needed to extend the range of image guided bronchoscopy. At the heart of this application is the development of automated-methods for obtaining virtual endoscopic pathways leading to small peripheral lung nodules, including the use of pulmonary arteries as surrogate markers for the location of peripheral bronchi in those cases in which bronchi cannot be identified adjacent to lesions even using high-resolution near-isotropic CT images. These automated techniques can then be coupled with ultrathin bronchoscopy allowing the routine diagnosis of pulmonary nodules previously considered inaccessible to routine flexible bronchoscopy. Specific Aim 1 will be to create automatic virtual endoscopic roadmaps from central airways to small computer generated peripheral lung nodules as a means to assess the feasibility of automated pathway planning and airway/arterial correspondence. Specific Aim 2 will address the potential clinical application of these techniques in a Pilot Project. It is anticipated that these results will allow ultrathin bronchoscopy to emerge as the initial procedure of choice for assessing peripheral lung nodules thus altering present clinical paradigms.