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Marta Diez-Ferrer; Arturo Morales; Rosa Lopez Lisbona; Noelia Cubero; Cristian Tebe; Susana Padrones; Samantha Aso; Jordi Dorca; Debora Gil; Antoni Rosell |
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Title |
Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield |
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Journal Article |
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Year |
2019 |
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Respiration |
Abbreviated Journal |
RES |
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97 |
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3 |
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252-258 |
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Lung cancer; Peripheral lung lesion; Diagnosis; Bronchoscopy; Ultrathin bronchoscopy; Virtual bronchoscopic navigation |
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Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources. |
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IAM; 600.145; 600.139 |
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Admin @ si @ DML2019 |
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3134 |
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Marta Diez-Ferrer; Debora Gil; Cristian Tebe; Carles Sanchez |
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Title |
Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation |
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Journal Article |
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Year |
2018 |
Publication |
Respiration |
Abbreviated Journal |
RES |
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96 |
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6 |
Pages |
525-534 |
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Keywords |
Multidetector computed tomography; Bronchoscopy; Continuous positive airway pressure; Image enhancement; Virtual bronchoscopic navigation |
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Abstract
RATIONALE:
Virtual bronchoscopic navigation (VBN) guidance to peripheral pulmonary lesions is often limited by insufficient segmentation of the peripheral airways.
OBJECTIVES:
To test the effect of applying positive airway pressure (PAP) during CT acquisition to improve segmentation, particularly at end-expiration.
METHODS:
CT acquisitions in inspiration and expiration with 4 PAP protocols were recorded prospectively and compared to baseline inspiratory acquisitions in 20 patients. The 4 protocols explored differences between devices (flow vs. turbine), exposures (within seconds vs. 15-min) and pressure levels (10 vs. 14 cmH2O). Segmentation quality was evaluated with the number of airways and number of endpoints reached. A generalized mixed-effects model explored the estimated effect of each protocol.
MEASUREMENTS AND MAIN RESULTS:
Patient characteristics and lung function did not significantly differ between protocols. Compared to baseline inspiratory acquisitions, expiratory acquisitions after 15 min of 14 cmH2O PAP segmented 1.63-fold more airways (95% CI 1.07-2.48; p = 0.018) and reached 1.34-fold more endpoints (95% CI 1.08-1.66; p = 0.004). Inspiratory acquisitions performed immediately under 10 cmH2O PAP reached 1.20-fold (95% CI 1.09-1.33; p < 0.001) more endpoints; after 15 min the increase was 1.14-fold (95% CI 1.05-1.24; p < 0.001).
CONCLUSIONS:
CT acquisitions with PAP segment more airways and reach more endpoints than baseline inspiratory acquisitions. The improvement is particularly evident at end-expiration after 15 min of 14 cmH2O PAP. Further studies must confirm that the improvement increases diagnostic yield when using VBN to evaluate peripheral pulmonary lesions. |
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IAM; 600.145 |
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Admin @ si @ DGT2018 |
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3135 |
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Debora Gil; Antonio Esteban Lansaque; Agnes Borras; Carles Sanchez |
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Title |
Enhancing virtual bronchoscopy with intra-operative data using a multi-objective GAN |
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Journal Article |
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2019 |
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International Journal of Computer Assisted Radiology and Surgery |
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IJCAR |
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7 |
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1 |
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This manuscript has been withdrawn by bioRxiv due to upload of an incorrect version of the manuscript by the authors. Therefore, this manuscript should not be cited as reference for this project. |
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IAM; 600.139; 600.145 |
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no |
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Admin @ si @ GEB2019 |
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3307 |
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Author |
Debora Gil; Carles Sanchez; Agnes Borras; Marta Diez-Ferrer; Antoni Rosell |
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Title |
Segmentation of Distal Airways using Structural Analysis |
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Journal Article |
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Year |
2019 |
Publication |
PloS one |
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Plos |
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14 |
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12 |
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Segmentation of airways in Computed Tomography (CT) scans is a must for accurate support of diagnosis and intervention of many pulmonary disorders. In particular, lung cancer diagnosis would benefit from segmentations reaching most distal airways. We present a method that combines descriptors of bronchi local appearance and graph global structural analysis to fine-tune thresholds on the descriptors adapted for each bronchial level. We have compared our method to the top performers of the EXACT09 challenge and to a commercial software for biopsy planning evaluated in an own-collected data-base of high resolution CT scans acquired under different breathing conditions. Results on EXACT09 data show that our method provides a high leakage reduction with minimum loss in airway detection. Results on our data-base show the reliability across varying breathing conditions and a competitive performance for biopsy planning compared to a commercial solution. |
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IAM; 600.139; 600.145 |
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Admin @ si @ GSB2019 |
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3357 |
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Author |
Debora Gil; Antonio Esteban Lansaque; Agnes Borras; Esmitt Ramirez; Carles Sanchez |
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Title |
Intraoperative Extraction of Airways Anatomy in VideoBronchoscopy |
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Journal Article |
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Year |
2020 |
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IEEE Access |
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ACCESS |
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8 |
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159696 - 159704 |
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A main bottleneck in bronchoscopic biopsy sampling is to efficiently reach the lesion navigating across bronchial levels. Any guidance system should be able to localize the scope position during the intervention with minimal costs and alteration of clinical protocols. With the final goal of an affordable image-based guidance, this work presents a novel strategy to extract and codify the anatomical structure of bronchi, as well as, the scope navigation path from videobronchoscopy. Experiments using interventional data show that our method accurately identifies the bronchial structure. Meanwhile, experiments using simulated data verify that the extracted navigation path matches the 3D route. |
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IAM; 600.139; 600.145 |
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Admin @ si @ GEB2020 |
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3467 |
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