Virtual Bronchoscopy-Guided Transbronchial Biopsy Simulation Using a Head-Mounted Display: A New Style of Flexible Bronchoscopy

Background/need. The increases in reference images and information during bronchoscopy using virtual bronchoscopic navigation (VBN) and fluoroscopy has potentially created the need for support using a head-mounted display (HMD) because bronchoscopists feel difficulty to see displays that are at a distance from them and turn their head and body in various directions. Methodology and device description. The binocular see-through Moverio BT-35E Smart Glasses can be connected via a high-definition multimedia interface and have a 720p high-definition display. We developed a system that converts fluoroscopic (live and reference), VBN, and bronchoscopic image signals through a converter and references them using the Moverio BT-35E. Preliminary results. We performed a virtual bronchoscopy-guided transbronchial biopsy simulation using the system. Four experienced pulmonologists performed a simulated bronchoscopy of 5 cases each with the Moverio BT-35E glasses, using bronchoscopy training model. For all procedures, the bronchoscope was advanced successfully into the target bronchus according to the VBN image. None of the operators reported eye or body fatigue during or after the procedure. Current status. This small-scale simulation study suggests the feasibility of using a HMD during bronchoscopy. For clinical use, it is necessary to evaluate the safety and usefulness of the system in larger clinical trials in the future.

Virtual Bronchoscopy Planner and Radial-EBUS Guided Biopsy for Organizing Pneumonia Diagnosis

Background: The diagnosis of organizing pneumonia (OP) often requires histological confirmation. The aim of this retrospective study was to evaluate the diagnostic yield and complication rate of radial endobronchial ultrasound (r-EBUS) for OP. Methods: All patients who had r-EBUS as a first diagnostic procedure for a peripheral pulmonary lesion at Rouen University Hospital, France, between April 2008 and December 2020 were included. Cases without a final diagnosis of OP or follow-up were excluded. Patients, lesions, and r-EBUS characteristics were retrospectively analyzed. Results: 2735 r-EBUS procedures were performed, and 33 cases with final OP could be analyzed. Procedures were performed under local anesthesia in 28/33 cases (85%). Among the 33 final OP cases, 17 were considered cryptogenic, and 16 secondary. The lesions were patchy alveolar opacities in 23 cases (70%), masses or pulmonary nodules in 8 cases (24%), and diffuse infiltrative opacities in 2 cases (6%). A bronchus sign on CT scan was found in all cases. In 22 cases (67%), a histopathological diagnosis was obtained from the r-EBUS samples. In 4 cases (12%), histopathological diagnosis was made by surgery, and in 7 cases (21%) the diagnosis was made based on clinical, radiological, and evolution features. An ultrasound image was found in 100% (22/22) of cases in the r-EBUS positive (r-EBUS+) group vs. 60% (6/10) in the r-EBUS negative (r-EBUS-) group, respectively (p < 0.002). The diagnostic yield of r-EBUS for OP was 67% and increased to 79% (22/28) when an ultrasound image was obtained. The median time between CT scan and r-EBUS procedure was 14 days (3–94): 11.5 days in the r-EBUS+ group and 22 days in the r-EBUS- group (p < 0.0001). No severe complications were reported. Conclusion: r-EBUS, when performed shortly after a CT scan showing a bronchus sign, is an efficient and safe technique for OP diagnosis.

First assessment of comparative efficacy of virtual bronchoscopy and radial endobronchial ultrasound for minimally invasive diagnosis of peripheral pulmonary lesions

Data regarding the efficacy of virtual bronchoscopy (VB) compared to radial endobronchial ultrasound (rEBUS) for minimally invasive diagnostics of peripheral pulmonary lesions (PPLs) are still controversial.Aim. To assess the comparative efficacy of VB versus VB plus rEBUS in patients with PPLs.Methods. The study enrolled 36 subjects with PPLs detected by chest high resolution computed tomography (HRCT). All patients had bronchoscopy with various biopsy methods (based on navigation) alone or in combination with each other, followed by cytological, histological (if the biopsy sample was available), and microbiological analysis of the specimens. The subjects were randomized into two groups depending on the navigation technique: VB + rEBUS group (I) and VB group (II). VB (Osirix) was done as a planning procedure before real bronchoscopy with rEBUS navigation (Olympus UM-S20-17S) in group I. In group II VB was the only navigation technique.Results. Overall diagnostic yield (d. y.) reached 60% and 56% for groups I and II, respectively. In group I, the d.y. reached 86% for malignancy and 42% for other benign diseases. In group II, the d.y. reached 100% for malignancy and 36% for other benign diseases. The navigation efficacy was higher in the presence of a draining bronchus sign according to chest HRCT, lesion size more than 20 mm, upper lobe peripheral lesion. In group I, detecting the lesion with the ultrasound radial mini probe was also a predictor of efficacy. In group II, abnormal intraluminal bronchial anatomy according to VB as a sign of central lung cancer was also a predictor of efficacy.Conclusion. Both rEBUS and VB are safe and effective navigation techniques that provide for highly effective minimally invasive diagnosis of PPLs. VB could be a sound alternative when rEBUS is unavailable.

Virtual Bronchoscopy as the Guide for Fiberoptic Bronchoscopy in Evaluating Tracheobronchial Disorders in the Bronchogenic Carcinoma

Fiberoptic bronchoscopy (FOB) is one of the important modalities in helping to uphold the diagnosis and stadium of bronchogenic carcinoma. However, FOB has some limitations, namely invasive, time-consuming, requiring sedation, intolerable in patients who are critically ill, and difficult to evaluate distal airway side of severe stenosis. To identify the imaging capability of virtual bronchoscopy (VB) examinations in evaluating abnormalities in the tracheobronchial in bronchogenic carcinoma. Observational study with total sampling. Data was obtained from the histopathologic with diagnosis of bronchogenic carcinoma in 1 year. Retrospectively, the data were obtained from the archives of thoracic CT examinations in Radiology and FOB examination in Lung Operating Room. The variables assessed were the finding of mass of endobronchial based on its location, the main bronchi constriction, lobar bronchi constriction, segmental bronchi constriction, and compression/tracheal deformity. The results of VB were examined by three radiologists independently and were then compared with the results of FOB. The observation results of VB and FOB were used to analyse the degree of conformity. There is a low level of agreement on the finding of endobronchial mass, lobar bronchi and segmental bronchi constriction, sufficient level of agreement on the main bronchial constriction finding. VB has a limited capacity to evaluate abnormalities of the tracheobronchial compared with FOB, but VB has an advantage in evaluating the patency of the distal airway of severe obstruction.

Overview of longstanding bronchial foreign bodies and role of virtual bronchoscopy

<p><strong>Background:</strong> Virtual bronchoscopy (VB) is a software based, three-dimensional visualization format created from non-invasive medical imaging methods such as CT and magnetic resonance imaging, with the goal of creating views similar to minimally invasive bronchoscopy procedure. The aim of the study was to find the usefulness of VB in diagnosing vegetative and non-vegetative longstanding intra bronchial foreign bodies (FB).</p><p><strong>Methods</strong>: This was a retrospective and prospective cross-sectional study conducted in the department of otorhinolaryngology M. G. M. M. C and M. Y. hospital Indore for a period of 5 years. The medical records of patients with FB aspiration from august 2006 to September 2015 were reviewed. Data was collected regarding their clinical presentation examination and chest x-ray findings. Patients with suspected FB aspiration were subjected to VB and rigid bronchoscopy was performed.<strong></strong></p><p><strong>Results: </strong>In the subjects, we observed that chest radiograph were normal in as many as 40% cases. Hence negative chest radiographs do not rule out FB. In 48 patients with FB aspiration, which was detected by VB, 46 patients were diagnosed to have FB on rigid bronchoscopy. This amounts to a positive predictive value of 98%, which was similar to the gold standard, which is rigid bronchoscopy which had a positive predictive value of 99%.</p><p><strong>Conclusions: </strong>VB is the only imaging modality which gives 99.9% reassurance about the presence or absence of a FB, because of its high sensitivity and specificity, hence proves to be a lifesaving tool.</p>