Electromagnetic navigated EBUS-TBNA, procedure workflow.

<p>Preoperative preparations included target definition, CT model extraction and image import into the navigation software. During the EBUS procedure, image-to-patient registration was performed using an automatic algorithm in the navigation software. A combination of video, electromagnetic navigated bronchoscopy (ENB) and EBUS was used for target localization and confirmation before EBUS guided fine needle sampling. A variety of options existed for image reconstruction during the procedure or postoperatively.</p

Navigated EBUS: Technical outcomes.

<p>Navigated EBUS: Technical outcomes.</p

Navigation system accuracy, patient 3.

<p>(C, D) Orthogonal EBUS planes were projected on top of corresponding planes from the segmented CT models. Here, the axial plane is chosen for method illustration. (B, D) The EBUS and CT position of a 10R lymph node and the superior vena cava after manual shift correction. The resulting position deviation between EBUS and CT was combined for three planes, representing the navigation system accuracy. RMB = Right main bronchus. VCS = Superior vena cava.</p

Schematic operating room setup during navigated EBUS-TBNA.

<p>Preoperative images in DICOM format were imported into the navigation software, and matched to the patient’s position during bronchoscopy (EM-CT-patient registration). When maneuvering the bronchoscope within the electromagnetic tracking (EM) field, the position of the bronchoscope sensor (BS) and EBUS images could be acquired in the navigation system. A reference electromagnetic sensor (RS) was attached on the table.</p

Graphical user interface, patient 4.

<p>(A) The CT models of the central airways, a 4R and a 4L lymph node target, the tip of the EBUS-scope and the real-time EBUS image. (B) The corresponding image plane from preoperative CT. The thin white sector represents the exact position of the EBUS image. (C) Regular, real-time EBUS image, showing the 4R lymph node (arrow).</p

Navigated EBUS: Patient baseline data and clinical outcomes.

<p>Navigated EBUS: Patient baseline data and clinical outcomes.</p

Experimental EBUS bronchoscope.

<p>The sensor for electromagnetic tracking was attached close to the convex probe in the tip of the bronchoscope. The connector to the sensor (arrow) was plugged into the control unit of the electromagnetic tracking system.</p

Labeling in Mimics.

<p>The figure shows the centerline labeling in MPM. fig B display centerline extracted and fig B list labelling with Mimics.</p

The figure shows a detail of segmentation in MPM.

<p>The leakage is well visible at the end of the branches as “clouds” around the branch. The user can select manually the leakage that has to be removed (red segment) and put the leakage marker in its place (purple ball).</p

CustusX GUI for TSF.

<p>axial, coronal, sagittal view (right side), 3D model of the airway with centerline (center) and configuration filter parameters (left side).</p