Additional file 2: of Medical complexity and time to lung cancer treatment – a three-year retrospective chart review

Medical complexity and time to lung cancer treatment. (DO 25 kb

Navigated EBUS: Patient baseline data and clinical outcomes.

<p>Navigated EBUS: Patient baseline data and clinical 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

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

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

Thoracic computer tomography (CT) throughout the disease course.

<p>A large mediastinal tumour as well as thoracic wall infiltration was seen on the left side (CT at the same level). For details see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040521#s2" target="_blank">Methods</a>.</p

Top 10 overexpressed and down-regulated pathways in post- versus pre-resistance tumour in KEGG pathways map.

<p>Several interesting and important systems were deregulated after resistance. Note that overexpressed genes in GO metabolic process was 89 and in KEGG only 18. The reason is that KEGG includes new genes in a pathway only when several publications have confirmed it, and thus is more conservative but with a high level of evidence. Most pronounced were the metabolism and modification of DNA and RNA through pyrimidine and purine metabolism and aminoacyl-t-RNA biosynthesis. Interestingly, down-regulation of cell adhesion molecules and leukocyte transendothelial migration as well as cytokine-cytokine receptor interaction was pronounced, also an expression characteristic of mesothelioma versus normal pleura.</p