Image-Based Bronchial Anatomy Codification for Biopsy Guiding in Video Bronchoscopy

Bronchoscopy examinations allow biopsy of pulmonary nodules with minimum risk for the patient. Even for experienced bronchoscopists, it is difficult to guide the bronchoscope to most distal lesions and obtain an accurate diagnosis. This paper presents an image-based codification of the bronchial anatomy for bronchoscopy biopsy guiding. The 3D anatomy of each patient is codified as a binary tree with nodes representing bronchial levels and edges labeled using their position on images projecting the 3D anatomy from a set of branching points. The paths from the root to leaves provide a codification of navigation routes with spatially consistent labels according to the anatomy observes in video bronchoscopy explorations. We evaluate our labeling approach as a guiding system in terms of the number of bronchial levels correctly codified, also in the number of labels-based instructions correctly supplied, using generalized mixed models and computer-generated data. Results obtained for three independent observers prove the consistency and reproducibility of our guiding system. We trust that our codification based on viewer's projection might be used as a foundation for the navigation process in Virtual Bronchoscopy systems

Intraoperative Extraction of Airways Anatomy in VideoBronchoscopy

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

Optimizing parameters of an open-source airway segmentation algorithm using different CT images.

Background: Computed tomography (CT) helps physicians locate and diagnose pathological conditions. In some conditions, having an airway segmentation method which facilitates reconstruction of the airway from chest CT images can help hugely in the assessment of lung diseases. Many efforts have been made to develop airway segmentation algorithms, but methods are usually not optimized to be reliable across different CT scan parameters. Methods: In this paper, we present a simple and reliable semi-automatic algorithm which can segment tracheal and bronchial anatomy using the open-source 3D Slicer platform. The method is based on a region growing approach where trachea, right and left bronchi are cropped and segmented independently using three different thresholds. The algorithm and its parameters have been optimized to be efficient across different CT scan acquisition parameters. The performance of the proposed method has been evaluated on EXACT’09 cases and local clinical cases as well as on a breathing pig lung phantom using multiple scans and changing parameters. In particular, to investigate multiple scan parameters reconstruction kernel, radiation dose and slice thickness have been considered. Volume, branch count, branch length and leakage presence have been evaluated. A new method for leakage evaluation has been developed and correlation between segmentation metrics and CT acquisition parameters has been considered. Results: All the considered cases have been segmented successfully with good results in terms of leakage presence. Results on clinical data are comparable to other teams’ methods, as obtained by evaluation against the EXACT09 challenge, whereas results obtained from the phantom prove the reliability of the method across multiple CT platforms and acquisition parameters. As expected, slice thickness is the parameter affecting the results the most, whereas reconstruction kernel and radiation dose seem not to particularly affect airway segmentation. Conclusion: The system represents the first open-source airway segmentation platform. The quantitative evaluation approach presented represents the first repeatable system evaluation tool for like-for-like comparison between different airway segmentation platforms. Results suggest that the algorithm can be considered stable across multiple CT platforms and acquisition parameters and can be considered as a starting point for the development of a complete airway segmentation algorithm

Multidetector row CT for imaging the paediatric tracheobronchial tree

The introduction of multidetector row computed tomography (MDCT) scanners has altered the approach to imaging the paediatric thorax. In an environment where the rapid acquisition of CT data allows general hospitals to image children instead of referring them to specialist paediatric centres, it is vital that general radiologists have access to protocols appropriate for paediatric applications. Thus a dramatic reduction in the delivered radiation dose is ensured with optimal contrast bolus delivery and timing, and inappropriate repetition of the scans is avoided. This article focuses on the main principles of volumetric CT imaging that apply generically to all MDCT scanners. We describe the reconstruction techniques for imaging the paediatric thorax and the low-dose protocols used in our institution on a 16-slice detector CT scanner. Examples of the commonest clinical applications are also given

Automatic extraction of bronchus and centerline determination from CT images for three dimensional virtual bronchoscopy.

Law Tsui Ying.Thesis (M.Phil.)--Chinese University of Hong Kong, 2000.Includes bibliographical references (leaves 64-70).Abstracts in English and Chinese.Acknowledgments --- p.iiChapter 1 --- Introduction --- p.1Chapter 1.1 --- Structure of Bronchus --- p.3Chapter 1.2 --- Existing Systems --- p.4Chapter 1.2.1 --- Virtual Endoscope System (VES) --- p.4Chapter 1.2.2 --- Virtual Reality Surgical Simulator --- p.4Chapter 1.2.3 --- Automated Virtual Colonoscopy (AVC) --- p.5Chapter 1.2.4 --- QUICKSEE --- p.5Chapter 1.3 --- Organization of Thesis --- p.6Chapter 2 --- Three Dimensional Visualization in Medicine --- p.7Chapter 2.1 --- Acquisition --- p.8Chapter 2.1.1 --- Computed Tomography --- p.8Chapter 2.2 --- Resampling --- p.9Chapter 2.3 --- Segmentation and Classification --- p.9Chapter 2.3.1 --- Segmentation by Thresholding --- p.10Chapter 2.3.2 --- Segmentation by Texture Analysis --- p.10Chapter 2.3.3 --- Segmentation by Region Growing --- p.10Chapter 2.3.4 --- Segmentation by Edge Detection --- p.11Chapter 2.4 --- Rendering --- p.12Chapter 2.5 --- Display --- p.13Chapter 2.6 --- Hazards of Visualization --- p.13Chapter 2.6.1 --- Adding Visual Richness and Obscuring Important Detail --- p.14Chapter 2.6.2 --- Enhancing Details Incorrectly --- p.14Chapter 2.6.3 --- The Picture is not the Patient --- p.14Chapter 2.6.4 --- Pictures-'R'-Us --- p.14Chapter 3 --- Overview of Advanced Segmentation Methodologies --- p.15Chapter 3.1 --- Mathematical Morphology --- p.15Chapter 3.2 --- Recursive Region Search --- p.16Chapter 3.3 --- Active Region Models --- p.17Chapter 4 --- Overview of Centerline Methodologies --- p.18Chapter 4.1 --- Thinning Approach --- p.18Chapter 4.2 --- Volume Growing Approach --- p.21Chapter 4.3 --- Combination of Mathematical Morphology and Region Growing Schemes --- p.22Chapter 4.4 --- Simultaneous Borders Identification Approach --- p.23Chapter 4.5 --- Tracking Approach --- p.24Chapter 4.6 --- Distance Transform Approach --- p.25Chapter 5 --- Automated Extraction of Bronchus Area --- p.27Chapter 5.1 --- Basic Idea --- p.27Chapter 5.2 --- Outline of the Automated Extraction Algorithm --- p.28Chapter 5.2.1 --- Selection of a Start Point --- p.28Chapter 5.2.2 --- Three Dimensional Region Growing Method --- p.29Chapter 5.2.3 --- Optimization of the Threshold Value --- p.29Chapter 5.3 --- Retrieval of Start Point Algorithm Using Genetic Algorithm --- p.29Chapter 5.3.1 --- Introduction to Genetic Algorithm --- p.30Chapter 5.3.2 --- Problem Modeling --- p.31Chapter 5.3.3 --- Algorithm for Determining a Start Point --- p.33Chapter 5.3.4 --- Genetic Operators --- p.33Chapter 5.4 --- Three Dimensional Painting Algorithm --- p.34Chapter 5.4.1 --- Outline of the Three Dimensional Painting Algorithm --- p.34Chapter 5.5 --- Optimization of the Threshold Value --- p.36Chapter 6 --- Automatic Centerline Determination Algorithm --- p.38Chapter 6.1 --- Distance Transformations --- p.38Chapter 6.2 --- End Points Retrieval --- p.41Chapter 6.3 --- Graph Based Centerline Algorithm --- p.44Chapter 7 --- Experiments and Discussion --- p.48Chapter 7.1 --- Experiment of Automated Determination of Bronchus Algorithm --- p.48Chapter 7.2 --- Experiment of Automatic Centerline Determination Algorithm --- p.54Chapter 8 --- Conclusion --- p.62Bibliography --- p.6

Open-source virtual bronchoscopy for image guided navigation

This thesis describes the development of an open-source system for virtual bronchoscopy used in combination with electromagnetic instrument tracking. The end application is virtual navigation of the lung for biopsy of early stage cancer nodules. The open-source platform 3D Slicer was used for creating freely available algorithms for virtual bronchscopy. Firstly, the development of an open-source semi-automatic algorithm for prediction of solitary pulmonary nodule malignancy is presented. This approach may help the physician decide whether to proceed with biopsy of the nodule. The user-selected nodule is segmented in order to extract radiological characteristics (i.e., size, location, edge smoothness, calcification presence, cavity wall thickness) which are combined with patient information to calculate likelihood of malignancy. The overall accuracy of the algorithm is shown to be high compared to independent experts' assessment of malignancy. The algorithm is also compared with two different predictors, and our approach is shown to provide the best overall prediction accuracy. The development of an airway segmentation algorithm which extracts the airway tree from surrounding structures on chest Computed Tomography (CT) images is then described. This represents the first fundamental step toward the creation of a virtual bronchoscopy system. Clinical and ex-vivo images are used to evaluate performance of the algorithm. Different CT scan parameters are investigated and parameters for successful airway segmentation are optimized. Slice thickness is the most affecting parameter, while variation of reconstruction kernel and radiation dose is shown to be less critical. Airway segmentation is used to create a 3D rendered model of the airway tree for virtual navigation. Finally, the first open-source virtual bronchoscopy system was combined with electromagnetic tracking of the bronchoscope for the development of a GPS-like system for navigating within the lungs. Tools for pre-procedural planning and for helping with navigation are provided. Registration between the lungs of the patient and the virtually reconstructed airway tree is achieved using a landmark-based approach. In an attempt to reduce difficulties with registration errors, we also implemented a landmark-free registration method based on a balanced airway survey. In-vitro and in-vivo testing showed good accuracy for this registration approach. The centreline of the 3D airway model is extracted and used to compensate for possible registration errors. Tools are provided to select a target for biopsy on the patient CT image, and pathways from the trachea towards the selected targets are automatically created. The pathways guide the physician during navigation, while distance to target information is updated in real-time and presented to the user. During navigation, video from the bronchoscope is streamed and presented to the physician next to the 3D rendered image. The electromagnetic tracking is implemented with 5 DOF sensing that does not provide roll rotation information. An intensity-based image registration approach is implemented to rotate the virtual image according to the bronchoscope's rotations. The virtual bronchoscopy system is shown to be easy to use and accurate in replicating the clinical setting, as demonstrated in the pre-clinical environment of a breathing lung method. Animal studies were performed to evaluate the overall system performance

Towards Robot Autonomy in Medical Procedures Via Visual Localization and Motion Planning

Robots performing medical procedures with autonomous capabilities have the potential to positively effect patient care and healthcare system efficiency. These benefits can be realized by autonomous robots facilitating novel procedures, increasing operative efficiency, standardizing intra- and inter-physician performance, democratizing specialized care, and focusing the physician’s time on subtasks that best leverage their expertise. However, enabling medical robots to act autonomously in a procedural environment is extremely challenging. The deforming and unstructured nature of the environment, the lack of features in the anatomy, and sensor size constraints coupled with the millimeter level accuracy required for safe medical procedures introduce a host of challenges not faced by robots operating in structured environments such as factories or warehouses. Robot motion planning and localization are two fundamental abilities for enabling robot autonomy. Motion planning methods compute a sequence of safe and feasible motions for a robot to accomplish a specified task, where safe and feasible are defined by constraints with respect to the robot and its environment. Localization methods estimate the position and orientation of a robot in its environment. Developing such methods for medical robots that overcome the unique challenges in procedural environments is critical for enabling medical robot autonomy. In this dissertation, I developed and evaluated motion planning and localization algorithms towards robot autonomy in medical procedures. A majority of my work was done in the context of an autonomous medical robot built for enhanced lung nodule biopsy. First, I developed a dataset of medical environments spanning various organs and procedures to foster future research into medical robots and automation. I used this data in my own work described throughout this dissertation. Next, I used motion planning to characterize the capabilities of the lung nodule biopsy robot compared to existing clinical tools and I highlighted trade-offs in robot design considerations. Then, I conducted a study to experimentally demonstrate the benefits of the autonomous lung robot in accessing otherwise hard-to-reach lung nodules. I showed that the robot enables access to lung regions beyond the reach of existing clinical tools with millimeter-level accuracy sufficient for accessing the smallest clinically operable nodules. Next, I developed a localization method to estimate the bronchoscope’s position and orientation in the airways with respect to a preoperatively planned needle insertion pose. The method can be used by robotic bronchoscopy systems and by traditional manually navigated bronchoscopes. The method is designed to overcome challenges with tissue motion and visual homogeneity in the airways. I demonstrated the success of this method in simulated lungs undergoing respiratory motion and showed the method’s ability to generalize across patients.Doctor of Philosoph