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Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy.

ABSTRACT: Guided bronchoscopy offers a minimally invasive and safe method for accessing indeterminate pulmonary nodules. However, all current guided bronchoscopy systems rely on a preprocedural computed tomography (CT) scan to create a virtual map of the patient's airways. Changes in lung anatomy between the preprocedural CT scan and the bronchoscopy procedure can lead to a divergence between the expected and actual location of the target lesion. Termed "CT-to-body divergence", this effect reduces diagnostic yield, adds time to the procedure, and can be challenging for the operator. The objective of this paper is to describe the concept of CT-to-body divergence, its contributing factors, and methods and technologies that might minimize its deleterious effects on diagnostic yield.

SUBMITTER: Pritchett MA

PROVIDER: S-EPMC7212155 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy.

Pritchett Michael A MA Bhadra Krish K Calcutt Mike M Folch Erik E

Journal of thoracic disease 20200401 4

Guided bronchoscopy offers a minimally invasive and safe method for accessing indeterminate pulmonary nodules. However, all current guided bronchoscopy systems rely on a preprocedural computed tomography (CT) scan to create a virtual map of the patient's airways. Changes in lung anatomy between the preprocedural CT scan and the bronchoscopy procedure can lead to a divergence between the expected and actual location of the target lesion. Termed "CT-to-body divergence", this effect reduces diagnos ...[more]

PMID: 32395297

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Project description:Virtual anthropology (VA) is based on applying anthropological methods currently used to analyse bones to 3D models of human remains. While great advances have been made in this endeavour in the past decade, several interrogations concerning how reliable these models are and what their proper use should be remain unanswered. In this research, a fundamental assumption of VA has been investigated: if the way we perceive and apply an anthropological method is truly similar when looking at bones macroscopically and through various 3D media. In order to answer, 10 skulls of known age and sex were scanned using a computed tomography (CT) scanner and a 3D surface scanner. Two observers separately applied a defined staging method to eight suture sites on these skulls, first looking at the bone macroscopically, then at the 3D surface scan, and finally on the CT scan. Two rounds of observation were carried out by each observer. Intra- and inter-observer error were evaluated, and two sample t-tests used to evaluate if the different types of medium used yielded significantly different observations. The results show a high degree of inter-observer error, and that data obtained from 3D surface scans differ from macroscopic observation (confidence level 95%, P ≤ 0.05). CT scans, in these settings, yielded results comparable to those obtained through macroscopic observations. These results offer many possibilities for future research, including indications on the kind of anthropological methods and anatomical landmarks that might be reliably transferable to the virtual environment. All current methods used in traditional anthropology should be tested, and if they prove unreliable, new techniques to analyse bones from virtual models should be developed.Key pointsLarge discrepancies between observation on dry bones and computer-generated 3D models (surface scans or CT scans) could lead to the re-evaluation of the suitability of traditional anthropological methods for application on 3D models.This preliminary study evaluates whether macroscopic, 3D surface scans, and CT scans viewings generate different observations.The results indicate that the data are not always coherent across all three media of observation.Explanations include the aspect given to the bone by the 3D software, differences between handling bones in real life versus on a computer, and level of expertise of the observers.

Project description:In the clinical field of diagnosis and monitoring of bone diseases, high-resolution peripheral quantitative computed tomography (HR-pQCT) is an important imaging modality. It provides a resolution where quantitative bone morphometry can be extracted in vivo on patients. It is known that HR-pQCT provides slight differences in morphometric indices compared to the current standard approach micro-computed tomography (micro-CT). The most obvious reason for this is the restriction of the radiation dose and with this a lower image resolution. With advances in micro-CT evaluation techniques such as patient-specific remodeling simulations or dynamic bone morphometry, a higher image resolution would potentially also allow the application of such novel evaluation techniques to clinical HR-pQCT measurements. Virtual supersampling as post-processing step was considered to increase the image resolution of HR-pQCT scans. The hypothesis was that this technique preserves the structural bone morphometry. Supersampling from 82 μm to virtual 41 μm by trilinear interpolation of the grayscale values of 42 human cadaveric forearms resulted in strong correlations of structural parameters (R2: 0.96-1.00). BV/TV was slightly overestimated (4.3%, R2: 1.00) compared to the HR-pQCT resolution. Tb.N was overestimated (7.47%; R2: 0.99) and Tb.Th was slightly underestimated (-4.20%; R2: 0.98). The technique was reproducible with PE%CV between 1.96% (SMI) and 7.88% (Conn.D). In a clinical setting with 205 human forearms with or without fracture measured at 82 μm resolution HR-pQCT, the technique was sensitive to changes between groups in all parameters (p < 0.05) except trabecular thickness. In conclusion, we demonstrated that supersampling preserves the bone morphometry from HR-pQCT scans and is reproducible and sensitive to changes between groups. Supersampling can be used to investigate on the resolution dependency of HR-pQCT images and gain more insight into this imaging modality.

Project description:BackgroundPancreatic perfusion computed tomography (CT) imaging is increasingly used for neoplastic grading, predicting prognosis, and evaluating the response to therapy. To optimize the clinical pancreatic CT perfusion imaging methods, we evaluated 2 different CT scanning protocols concerning pancreas perfusion parameters.MethodsA retrospective study was conducted on 40 patients who underwent whole pancreas CT perfusion scanning in The First Affiliated Hospital of Zhengzhou University. Of these 40 patients, 20 patients in group A underwent continuous perfusion scanning, while 20 patients in group B underwent intermittent perfusion scanning. For group A, continuous axial scanning was performed 25 times, and the total scan time was 50 s. For group B, arterial phase helical perfusion scanning was performed 8 times, and then venous phase helical perfusion scanning was performed 15 times, with a total scan time of 64.6 to 70.0 s. A comprehensive list of perfusion parameters between different parts of the pancreas and the 2 groups were compared. The effective radiation dose for the 2 scanning methods was analyzed.ResultsThe parameter of the mean slope of increase (MSI) at different pancreatic parts in group A differed (P=0.028). The pancreas head had the lowest value, and the tail had the highest (about a 20% difference). In group A compared to group B, the blood volume of the pancreatic head was smaller (15.256±2.925 vs. 16.953±3.602), the positive enhanced integral was smaller (0.307±0.050 vs. 0.344±0.060) and the permeability surface was larger (34.205±9. 612 vs. 24.377±8.413); the blood volume of the pancreatic neck was smaller (13.940±2.691 vs. 17.173±3.918), the positive enhanced integral was smaller (0.304±0.088 vs. 0.361±0.051) and the permeability surface was larger (34.898±11.592 vs. 25. 794±8.149); the blood volume of the pancreatic body was smaller (16.142±4.006 vs. 18.401±2.513), the positive enhanced integral was smaller (0.305±0.093 vs. 0.342±0.048) and the permeability surface was larger (28.861±10.448 vs. 22.158±6. 017); the blood volume of the pancreatic tail was smaller (16.446±3.709 vs. 17.374±3.781), the positive enhanced integral was smaller (0.304±0.057 vs. 0.350±0.073) and the permeability surface was larger (27.823±8.228 vs. 21.509±7.768) (P<0.05). The effective radiation dose in the intermittent scan mode was slightly lower at 16.657±2.259 mSv than in the continuous scan mode (17.973±3.698 mSv).ConclusionsDifferent CT scanning intervals had a significant influence on whole pancreas blood volume, permeability surface, and positive enhanced integral. These demonstrate the high sensitivity of intermittent perfusion scanning for identifying perfusion abnormalities. Therefore, for the diagnosis of pancreatic diseases, intermittent pancreatic CT perfusion may be more advantageous.

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Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy.

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Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy.

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