Image-guided bronchoscopy for comprehensive lymph node staging

Lung cancer is the deadliest form of cancer. A bronchoscopic lymph node staging procedure is used to determine the stage of lung cancer. In this procedure, the physician samples tissue extracted from multiple diagnostic sites in the central chest, including lymph nodes and suspect tumors, using a bronchoscope to examine for cancer spread. Although best practice guidelines recommend a diverse set of sampling locations, most physicians only sample the bare minimum number of nodes during a staging procedure. Image-guided bronchoscopy (IGB) systems aid in guidance by using a patient's three-dimensional (3D) x-ray computed tomography (CT) image to create a virtual chest model and plan airway routes to chest regions of interest (ROIs). This plan is then executed in follow-on live guidance. Current IGB systems do not create plans for comprehensive nodal staging; they only enable individual ROI guidance and rely on the physician to select the order of ROIs. We now propose a full image-based methodology for guiding comprehensive, multi-destination lymph node staging procedures to span this gap. The complete methodology involves two components: 1) a procedure planning protocol to optimize bronchoscope sampling order; and 2) a guidance strategy and graphical user interface (GUI) designed for multi-destination staging procedures. We present results demonstrating the system and its application.