Lung cancer treatment using augmented fluoroscopic bronchoscopy
The technology that overlays digital technology on the real world is called “Augmented Reality” (AR).
As an application of this technology, a new technique called “Augmented Fluoroscopy (AF)” has appeared, which overlays data obtained from CT on an X-ray fluoroscopy screen. At our hospital, we apply this technology to bronchoscopes.
As a side note, bronchoscopy is an endoscopy to diagnose diseases of the lungs and bronchi, also known as a ‘lung camera’. It is thinner than a standard gastroscopy and has a small CCD camera on the tip, which allows the inside of the bronchi to be viewed from inside the mouth on an external monitor. It is used to diagnose suspected diseases such as lung cancer, interstitial pneumonia and infections.
Recently, with the development of imaging equipment, it has become possible to detect even small size lung cancers. However, in addition to the difficulty of performing histological examinations using bronchoscopy due to their small size, it has also been difficult to find the exact location of the cancer and remove it, even if surgery is performed.
To overcome this, augmented fluoroscopy (AF) has been used with great success in examinations and surgery (augmented fluoroscopy bronchoscopy).
Specifically, a three-dimensional image is created from the CT image data taken, and the areas with small lesions (biological changes caused by the disease) are clearly displayed on the image.
This image is used as a navigation image for tissue examination via bronchoscopy. (Fig. 1: Bronchoscopic biopsy using augmented fluoroscopy. Projecting the visualized tumor and the bronchoscope’s residual image helps with positioning.)
In addition, this technology can be used for surgical marking (A small metal coil that can be seen on x-rays is placed in the lungs.) (Fig. 2: Coil marking using augmented fluoroscopy. A: Relationship between visualized tumor and catheter, B: Visualized tumor and coil, C: True tumor and coil relationship in CT after placement (green: tumor, red: coil)), leading to more precise and accurate diagnosis and resection of lung cancer.
A: relationship between visualised tumour and catheter,
B: visualised tumour and coil,
C: relationship between true tumour and coil by CT after implantation (green: tumour, red coil).
The use of such image fusion technology has greatly increased the accuracy of diagnosis and resection of small lung cancers, which used to be very difficult. This is a new initiative that we are focusing on even more in our department.