Ultrafast Tomosynthesis for Transbronchial Biopsy Guidance

描述（由申请人提供）：肺癌筛查项目导致可疑病变活检数量显著增加。经支气管穿刺活检（TBNbx）比其他选择更受欢迎，因为它是微创的，并且已被证明比CT引导下的经皮穿刺活检和手术活检更舒适、更安全。一种安全、低剂量、省时的TBNbx引导技术是电磁导航支气管镜（ENB），它通过在先前的CT和电磁导航板以及传感器探针之间进行手动配准，将活检工具引导到支气管树内的预定位置。对于支气管树下更远的病变活检，ENB的准确性降低，主要是由于呼吸运动、身体运动等引起的CT与身体的偏离（干预时之前的CT与身体之间的误配）。因此，目前的文献建议需要一种多模态制导策略，将成像技术与ENB相结合，以提供实时图像制导（IG）。我们提出了一种新的临床可行的三维实时成像系统：1)允许实时同时可视化目标结节，支气管树和针/活检仪器，2)提供准确，高分辨率的三维体积信息，以提供目标和针的定位，以及3)保持患者和操作员尽可能低的剂量。我们的方法基于“逆几何”扫描光束数字x射线（SBDX）系统-一个大面积扫描阳极x射线源和一个小面积非常快的数字探测器。使用该系统，可以在1/30秒内获得物体的断层合成图像（平面内分辨率0.2mm，切片厚度5mm），辐射剂量水平与传统透视相当。本课题的具体目标是：1)优化用于肺结节检测的SBDX硬件；2)开发SBDX数据重构的实时、并发重构硬件和软件；3)在离体呼吸肺模型中使用SBDX和ENB来证明TBNbx的准确性和收率的提高。虽然我们专注于TBNbx的指导，但我们系统的潜在应用程序远远超出了这个特定（尽管重要）的应用程序。我们优化的系统还可用于通过结节和肺组织获得碘造影剂的第一次灌注图像，并可促进微创手术的发展，以“现场”切除或治疗小的癌性病变。

DESCRIPTION (provided by applicant): Screening programs for lung cancer have led to a significant increase in the number of biopsies of suspicious lesions. Transbronchial needle biopsy (TBNbx) is preferred over other options because it is minimally invasive, and it has been shown to be more comfortable and much safer than both CT guided percutaneous needle biopsy and surgical biopsies. One safe, dose reducing and time-saving technique to guide TBNbx is electromagnetic navigation bronchoscopy (ENB), which guides biopsy tools to predetermined locations within the bronchial tree using manual registration between a prior CT and an electromagnetic navigation board and sensor probe. The accuracy of ENB degrades for lesion biopsies farther down the bronchial tree, mainly due to the CT- to-body divergence (a miss-registration between the prior CT and the body at the time of intervention) due to breathing motion, body motion, etc. Therefore, current literature suggests a need for a multimodality guidance strategy that combines imaging techniques with ENB to provide real-time image guidance (IG). We propose a new clinically viable 3D real-time imaging system that : 1) permits real-time simultaneous visualization of the target nodule, bronchial tree, and the needle/biopsy instrument, 2) provides accurate, high resolution 3D volume information to provide localization of the target and needle, and 3) maintains patient and operator dose as low as possible. We base our approach on the 'inverse geometry' scanned beam digital x-ray (SBDX) system - a large-area scanned anode x-ray source and a small- area very fast digital detector. Using this system, tomosynthesis images of an object (in-plane resolution 0.2mm, slice thickness 5mm) can be acquired in as little as 1/30 of a second with radiation dose levels comparable to conventional fluoroscopy. The specific goals of this proposal are: 1) to optimize the SBDX hardware for lung nodule detection; 2) to develop real-time, concurrent reconstruction hardware and software for SBDX data reconstruction; and 3) to demonstrate improved accuracy and yield of TBNbx using SBDX and ENB in an ex vivo breathing lung model. While we have focused on guidance of TBNbx, the potential applications for our system go far beyond this specific (though important) application. Our optimized system could also be used to obtain first-pass perfusion images of iodinated contrast through nodules and lung tissue, and could facilitate the development of minimally invasive procedures for 'on the spot' resection or therapy of small, cancerous lesions. PUBLIC HEALTH RELEVANCE: We propose a new 3D real-time tomosynthesis imaging system to be used in conjunction with electromagnetic navigation bronchoscopy for image guidance of transbronchial needle biopsy procedures. The proposed system will provide 3D real-time visualization of the target nodule, bronchial tree, and the biopsy instrument with radiation levels comparable to conventional fluoroscopy. Our proposed system has the potential to directly contribute to a more effective and potentially earlier diagnosis of lung cancer.