Bronchoscopy using a head-mounted mixed reality device—a phantom study and a first in-patient user experience

Background: Bronchoscopy for peripheral lung lesions may involve image sources such as computed tomography (CT), fluoroscopy, radial endobronchial ultrasound (R-EBUS), and virtual/electromagnetic navigation bronchoscopy. Our objective was to evaluate the feasibility of replacing these multiple monitors with a head-mounted display (HMD), always providing relevant image data in the line of sight of the bronchoscopist.Methods: A total of 17 pulmonologists wearing a HMD (Microsoft® HoloLens 2) performed bronchoscopy with electromagnetic navigation in a lung phantom. The bronchoscopists first conducted an endobronchial inspection and navigation to the target, followed by an endobronchial ultrasound bronchoscopy. The HMD experience was evaluated using a questionnaire. Finally, the HMD was used in bronchoscopy inspection and electromagnetic navigation of two patients presenting with hemoptysis.Results: In the phantom study, the perceived quality of video and ultrasound images was assessed using a visual analog scale, with 100% representing optimal image quality. The score for video quality was 58% (95% confidence interval [CI] 48%–68%) and for ultrasound image quality, the score was 43% (95% CI 30%–56%). Contrast, color rendering, and resolution were all considered suboptimal. Despite adjusting the brightness settings, video image rendering was considered too dark. Navigation to the target for biopsy sampling was accomplished by all participants, with no significant difference in procedure time between experienced and less experienced bronchoscopists. The overall system latency for the image stream was 0.33–0.35 s. Fifteen of the pulmonologists would consider using HoloLens for navigation in the periphery, and two would not consider using HoloLens in bronchoscopy at all. In the human study, bronchoscopy inspection was feasible for both patients.Conclusion: Bronchoscopy using an HMD was feasible in a lung phantom and in two patients. Video and ultrasound image quality was considered inferior to that of video monitors. HoloLens 2 was suboptimal for airway and mucosa inspection but may be adequate for virtual bronchoscopy navigation

Patient EBUS 03

Patient 03 - CT and Ultrasoun

Patient EBUS 02

Patient 02 - CT and Ultrasoun

Data from: A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): a human feasibility study

Background: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. Aims: To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans. Methods: Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded. Results: Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered. Conclusions: Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation

Patient EBUS 01

Patient 01 - CT and Ultrasoun

Patient EBUS 04

Patient 04 - CT and Ultrasoun

A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): A human feasibility study

Background Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. Aims To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans. Methods Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded. Results Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered. Conclusions Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation

A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): A human feasibility study

Background Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. Aims To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans. Methods Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded. Results Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered. Conclusions Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation