Hayet Amalou MD, Abstract Co-Author: Nothing to Disclose

Neil Glossop PhD, Abstract Co-Author: Employee, Traxtal, Inc Intellectual property, Koninklijke Philips Electronics NV

Jochen Kruecker PhD, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Sheng Xu PhD, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Ken Olivier, Abstract Co-Author: Nothing to Disclose

Bradford J. Wood MD, Presenter: Support, Koninklijke Philips Electronics NV Support, Celsion Corporation Advisory Board, Koninklijke Philips Electronics NV Support, Biocompatibles International plc, UK Intellectual Property, Koninklijke Philips Electronics NV Intellectual Property, Traxtal, Inc

John W. Karanian PhD, Abstract Co-Author: Nothing to Disclose

William F. Pritchard MD, Abstract Co-Author: Nothing to Disclose

Alberto Chiesa, Abstract Co-Author: Nothing to Disclose

Ankur Kapoor PhD, Abstract Co-Author: Nothing to Disclose

Matthew Dreher PhD, Abstract Co-Author: Research support, Biocompatibles International plc Research support, Celsion Corporation

To evaluate the feasibility and workflow for image-guided endobronchial navigation within the lung to target peripheral lung lesions using electromagnetic instrument tracking.

A 7F diameter custom built steerable catheter was equipped with an electromagnetic sensor at the tip. The hollow catheter was used in conjunction with a preoperative CT scan to navigate to anatomical and metallic targets in the lungs of three swine. Anaesthetized animals were CT scanned with passive fiducials placed on the chest. Anatomical targets were then selected and recorded pre-operatively in the navigation software, a commercial image guided intervention system. Following semi-automated fiducial registration, the catheter was inserted through an endotracheal tube and navigated through the airways toward the target using axial, coronal and sagittal reformats of the CT data that automatically updated with movement of the catheter. When the operator determined that it was sufficiently close to the lesion, the navigation was terminated and the catheter location confirmed using CT.

Inexperienced users navigated the catheter without the use of a bronchoscope to within an average of 10.7mm of the target, as reported by the IGS tracking system. Average time from start to target was 5.1minutes. The system accuracy averaged 5.3mm compared to verification CT scans (displayed virtual location versus real location). The catheter was able to navigate extremely small peripheral airways. Semi-automated segmentation and path planning was also separately implemented.

EM tracking-equipped catheter technology enabled inexperienced users to quickly locate targets in the lungs without need of a bronchoscope. EM tracking of small caliber instruments may facilitate functional imaging-guided (PET-CT) transbronchial biopsies and interventions in the future.

Electromagnetic tracking guidance may potentially facillitate transbrochial diagnostic and therapeutic procedures.

Amalou, H, Glossop, N, Kruecker, J, Xu, S, Olivier, K, Wood, B, Karanian, J, Pritchard, W, Chiesa, A, Kapoor, A, Dreher, M, Steerable Endobronchial Navigation with or without a Bronchoscope or Fiberoptic Visualization.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013893.html