Extemporaneous Airway Route Computation During Live Bronchoscopic Procedures

Image-guided bronchoscopy systems and new robotics-assisted bronchoscopy systems are transforming the practice of bronchoscopy. To use such a system, the physician must first create an airway route plan to preselected regions of interests (ROIs) using a patient's chest CT scan, prior to the live procedure. Many unexpected situations arise during the live procedure, however, where the physician must examine a new previously unplanned ROI site - this requires an airway guidance route leading to the new site derived live in real time. We propose a method for deriving an airway route during a live bronchoscopic procedure to any selected site in any imaging view or bronchoscopic video view observed on an assisted-bronchoscopy system's display. The method includes an interactive graphical tool for managing and selecting new ROI sites and fits within the framework of an assisted-bronchoscopy system. When a site is selected, the methodology draws on the patient's chest CT scan and a previously derived airway-tree centerline structure to compute the desired airway route in real-time. Subsequently, the physician can then preview the new airway route on the assisted-bronchoscopy system's display and undertake guided bronchoscopy to the new site. Example results demonstrate the methodology.