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）优于其他选择，因为它是微创的，并且已被证明比CT引导下经皮穿刺活检和手术活检更舒适，更安全。引导TBNbx的一种安全、剂量减少且节省时间的技术是电磁导航支气管镜检查（ENB），其使用先前CT与电磁导航板和传感器探头之间的手动配准将活检工具引导到支气管树内的预定位置。ENB的准确性在支气管树下游的病变活检中会降低，主要是由于呼吸运动、身体运动等导致的CT-身体发散（介入时先前CT和身体之间的配准错误）。因此，当前文献表明需要一种多模态引导策略，将成像技术与ENB相结合，以提供实时图像引导（IG）。 我们提出了一种新的临床可行的3D实时成像系统：1）允许实时同时可视化的目标结节，支气管树，和针/活检仪器，2）提供准确的，高分辨率的3D体积信息，以提供定位的目标和针，和3）保持患者和操作员的剂量尽可能低。我们的方法基于"逆几何"扫描束数字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速的数字探测器。使用该系统，可以在短至1/30秒的时间内采集对象的断层合成图像（平面内分辨率0.2mm，层厚5mm），辐射剂量水平与传统荧光透视相当。该提案的具体目标是：1）优化用于肺结节检测的SBDX硬件; 2）开发用于SBDX数据重建的实时、并发重建硬件和软件;以及3）证明在离体呼吸肺模型中使用SBDX和ENB的TBNbx的准确性和产率的提高。 虽然我们专注于TBNbx的指导，但我们系统的潜在应用远远超出了这个特定（尽管重要）的应用。我们的优化系统也可用于通过结节和肺组织获得碘化造影剂的首过灌注图像，并可促进微创手术的发展，用于"现场"切除或治疗小的癌性病变。 公共卫生相关性：我们提出了一种新的3D实时断层合成成像系统，与电磁导航支气管镜结合使用，用于经支气管穿刺活检手术的图像引导。申报系统将提供靶结节、支气管树和活检仪器的3D实时可视化，辐射水平与传统荧光透视相当。我们提出的系统有可能直接有助于肺癌的更有效和潜在的早期诊断。

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.