Abstract: Poster

Abstract: Endoscopic estimation of the degree of stenosis in central airway obstruction is subjective and highly variable. Objective: To determine the benefits of using SENSA (System for Endoscopic Stenosis Assessment), an image-based computational software, for obtaining objective stenosis index (SI) measurements among a group of expert bronchoscopists and general pulmonologists. Methods: A total of 7 expert bronchoscopists and 7 general pulmonologists were enrolled to validate SENSA usage. The SI obtained by the physicians and by SENSA were compared with a reference SI to set their precision in SI computation. We used SENSA to efficiently obtain this reference SI in 11 selected cases of benign stenosis. A Web platform with three user-friendly microtasks was designed to gather the data. The users had to visually estimate the SI from videos with and without contours of the normal and the obstructed area provided by SENSA. The users were able to modify the SENSA contours to define the reference SI using morphometric bronchoscopy. Results: Visual SI estimation accuracy was associated with neither bronchoscopic experience (p = 0.71) nor the contours of the normal and the obstructed area provided by the system (p = 0.13). The precision of the SI by SENSA was 97.7% (95% CI: 92.4-103.7), which is significantly better than the precision of the SI by visual estimation (p < 0.001), with an improvement by at least 15%. Conclusion: SENSA provides objective SI measurements with a precision of up to 99.5%, which can be calculated from any bronchoscope using an affordable scalable interface. Providing normal and obstructed contours on bronchoscopic videos does not improve physicians' visual estimation of the SI.

Abstract: Assistance systems for e-Health applications have some specific requirements that demand of new methods for data gathering, analysis and modeling able to deal with SmallData:
1) systems should dynamically collect data from, both, the environment and the user to issue personalized recommendations; 2) data analysis should be able to tackle a limited number of samples prone to include non-informative data and possibly evolving in time due to changes in patient condition; 3) algorithms should run in real time with possibly limited computational resources and fluctuant internet access.
Electronic medical devices (and CyberPhysical devices in general) can enhance the process of data gathering and analysis in several ways: (i) acquiring simultaneously multiple sensors data instead of single magnitudes (ii) filtering data; (iii) providing real-time implementations condition by isolating tasks in individual processors of multiprocessors Systems-on-chip (MPSoC) platforms and (iv) combining information through sensor fusion
techniques.
Our approach focus on both aspects of the complementary role of CyberPhysical devices and analysis of SmallData in the process of personalized models building for e-Health applications. In particular, we will address the design of Cyber-Physical Systems in Health for Personalized Assistance (CyberHealth) in two specific application cases: 1) A Smart Assisted Driving System (SADs) for dynamical assessment of the driving capabilities of Mild Cognitive Impaired (MCI) people; 2) An Intelligent Operating Room (iOR) for improving the yield of bronchoscopic interventions for in-vivo lung cancer diagnosis.

Abstract: A main weakness of virtual bronchoscopic navigation (VBN) is unsuccessful segmentation of distal branches approaching peripheral pulmonary nodules (PPN). CT scan acquisition protocol is pivotal for segmentation covering the utmost periphery. We hypothesize that application of continuous positive airway pressure (CPAP) during CT acquisition could improve visualization and segmentation of peripheral bronchi. The purpose of the present pilot study is to compare quality of segmentations under 4 CT acquisition modes: inspiration (INSP), expiration (EXP) and both with CPAP (INSP-CPAP and EXP-CPAP).

Abstract: Bronchoscopists use fluoroscopy to guide flexible bronchoscopy to the lesion to be biopsied without any kind of incision. Being fluoroscopy an imaging technique based on X-rays, the risk of developmental problems and cancer is increased in those subjects exposed to its application, so minimizing radiation is crucial. Alternative guiding systems such as electromagnetic navigation require specific equipment, increase the cost of the clinical procedure and still require fluoroscopy. In this paper we propose an image based guiding system based on the extraction of airway centres from intra-operative videos. Such anatomical landmarks are matched to the airway centreline extracted from a pre-planned CT to indicate the best path to the nodule. We present a
feasibility study of our navigation system using simulated bronchoscopic videos and a multi-expert validation of landmarks extraction in 3 intra-operative ultrathin explorations.