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22University of University of Iowa Iowa
Iowa City, IA Iowa City, IA 5224652246
22University of University of Iowa Iowa
Iowa City, IA Iowa City, IA 5224652246
William E. HigginsWilliam E. Higgins1,21,2 Anthony J. SherbondyAnthony J. Sherbondy11
James P. HelfertyJames P. Helferty11 Atilla P. KiralyAtilla P. Kiraly11
Geoffrey McLennanGeoffrey McLennan22 Eric A. HoffmanEric A. Hoffman22
Janice Z TurlingtonJanice Z Turlington11
William E. HigginsWilliam E. Higgins1,21,2 Anthony J. SherbondyAnthony J. Sherbondy11
James P. HelfertyJames P. Helferty11 Atilla P. KiralyAtilla P. Kiraly11
Geoffrey McLennanGeoffrey McLennan22 Eric A. HoffmanEric A. Hoffman22
Janice Z TurlingtonJanice Z Turlington11
RSNA 2000RSNA 2000Chicago, ILChicago, IL
26 November 200026 November 2000
RSNA 2000RSNA 2000Chicago, ILChicago, IL
26 November 200026 November 2000
11Penn State Penn State University University University University
Park, PA Park, PA 1680216802
11Penn State Penn State University University University University
Park, PA Park, PA 1680216802
1.1. Introduce the feasibility of PC-based Introduce the feasibility of PC-based virtual endoscopy for both 3D CT virtual endoscopy for both 3D CT assessment and live bronchoscopy.assessment and live bronchoscopy.
2.2. Demonstrate the concept of a multimedia Demonstrate the concept of a multimedia case study for CT-based report case study for CT-based report generation and bronchoscopic guidance.generation and bronchoscopic guidance.
3.3. Describe a method for linking 3D CT Describe a method for linking 3D CT data to live bronchoscopic video.data to live bronchoscopic video.
1.1. Introduce the feasibility of PC-based Introduce the feasibility of PC-based virtual endoscopy for both 3D CT virtual endoscopy for both 3D CT assessment and live bronchoscopy.assessment and live bronchoscopy.
2.2. Demonstrate the concept of a multimedia Demonstrate the concept of a multimedia case study for CT-based report case study for CT-based report generation and bronchoscopic guidance.generation and bronchoscopic guidance.
3.3. Describe a method for linking 3D CT Describe a method for linking 3D CT data to live bronchoscopic video.data to live bronchoscopic video.
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1.1. Overview of virtual bronchoscopy and our Overview of virtual bronchoscopy and our system (Virtual Navigator)system (Virtual Navigator)
2.2. Stage-1 CT-only Analysis: Stage-1 CT-only Analysis: Human caseHuman case
3.3. Stage-2 Bronchoscopy examples:Stage-2 Bronchoscopy examples:a.a. Human caseHuman caseb.b. Phantom and animal studiesPhantom and animal studies
1.1. Overview of virtual bronchoscopy and our Overview of virtual bronchoscopy and our system (Virtual Navigator)system (Virtual Navigator)
2.2. Stage-1 CT-only Analysis: Stage-1 CT-only Analysis: Human caseHuman case
3.3. Stage-2 Bronchoscopy examples:Stage-2 Bronchoscopy examples:a.a. Human caseHuman caseb.b. Phantom and animal studiesPhantom and animal studies
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virtual copy of chest anatomyvirtual copy of chest anatomy virtual copy of chest anatomyvirtual copy of chest anatomy
Input:Input:Input:Input:high-resolution 3D radiologic chest imagehigh-resolution 3D radiologic chest imagehigh-resolution 3D radiologic chest imagehigh-resolution 3D radiologic chest image
permits unlimited permits unlimited
“exploration”“exploration” no risk to patientno risk to patient
permits unlimited permits unlimited
“exploration”“exploration” no risk to patientno risk to patient
Explore:Explore:Explore:Explore:the virtual anatomy using computerthe virtual anatomy using computerthe virtual anatomy using computerthe virtual anatomy using computer
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Permit CT-only analysisPermit CT-only analysis
• No link to No link to follow-onfollow-on live bronchoscopy live bronchoscopy
Limited quantitative path planning to interesting sites Limited quantitative path planning to interesting sites
Do not provide complete examination packageDo not provide complete examination package
Often require expensive computersOften require expensive computers
Permit CT-only analysisPermit CT-only analysis
• No link to No link to follow-onfollow-on live bronchoscopy live bronchoscopy
Limited quantitative path planning to interesting sites Limited quantitative path planning to interesting sites
Do not provide complete examination packageDo not provide complete examination package
Often require expensive computersOften require expensive computers
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Complete CT Complete CT examination examination
Guide live Guide live bronchoscopybronchoscopy
Automate Automate steps in CT steps in CT assessment assessment
Inexpensive, Inexpensive, PC-basedPC-based
Complete CT Complete CT examination examination
Guide live Guide live bronchoscopybronchoscopy
Automate Automate steps in CT steps in CT assessment assessment
Inexpensive, Inexpensive, PC-basedPC-based
Build with Graphics/Processing ToolsBuild with Graphics/Processing Tools Build with Graphics/Processing ToolsBuild with Graphics/Processing Tools
3D CT assessment3D CT assessment3D CT assessment3D CT assessment
Guide bronchoscopyGuide bronchoscopyGuide bronchoscopyGuide bronchoscopy Supplemental plan Supplemental plan Supplemental plan Supplemental plan
Multimedia report Multimedia report Multimedia report Multimedia report
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3.3. Reporting AbstractionsReporting Abstractions SnapshotsSnapshots PlotsPlots MoviesMovies Case NotesCase Notes MeasurementsMeasurements
3.3. Reporting AbstractionsReporting Abstractions SnapshotsSnapshots PlotsPlots MoviesMovies Case NotesCase Notes MeasurementsMeasurements
1.1. Data SourcesData Sources 3D CT Image3D CT Image BronchoscopicBronchoscopic VideoVideo
1.1. Data SourcesData Sources 3D CT Image3D CT Image BronchoscopicBronchoscopic VideoVideo
2.2. Data AbstractionsData Abstractions Root SiteRoot Site Key SitesKey Sites PathsPaths TreeTree
2.2. Data AbstractionsData Abstractions Root SiteRoot Site Key SitesKey Sites PathsPaths TreeTree
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VirtualscopeVirtualscopeVirtualscopeVirtualscope
3D Surface Tool3D Surface Tool3D Surface Tool3D Surface ToolStudy ManagerStudy ManagerStudy ManagerStudy Manager
Projection ToolsProjection ToolsProjection ToolsProjection Tools
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Sliding Slab Depth ToolsSliding Slab Depth ToolsSliding Slab Depth ToolsSliding Slab Depth Tools
Plot ToolPlot ToolPlot ToolPlot ToolOblique Cross SectionsOblique Cross SectionsOblique Cross SectionsOblique Cross Sections
Slicer Tools (MPR Views)Slicer Tools (MPR Views)Slicer Tools (MPR Views)Slicer Tools (MPR Views)
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CT-Video Live Match ToolCT-Video Live Match ToolCT-Video Live Match ToolCT-Video Live Match ToolCube ToolCube ToolCube ToolCube Tool
Tube Viewer Tube Viewer Tube Viewer Tube Viewer Notes ToolNotes ToolNotes ToolNotes Tool
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Examine case and plan Examine case and plan bronchoscopybronchoscopyExamine case and plan Examine case and plan bronchoscopybronchoscopy
Virtual CT guidance of live Virtual CT guidance of live bronchoscopybronchoscopy
Virtual CT guidance of live Virtual CT guidance of live bronchoscopybronchoscopy
Stage 1:Stage 1:Stage 1:Stage 1:CT AssessmentCT AssessmentCT AssessmentCT Assessment
Stage 2:Stage 2:Stage 2:Stage 2:BronchoscopyBronchoscopyBronchoscopyBronchoscopy
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1.1.Create new Case Study.Create new Case Study.2.2.Compute guidance data.Compute guidance data.3.3.Build complete Case Study. Build complete Case Study.
1.1.Create new Case Study.Create new Case Study.2.2.Compute guidance data.Compute guidance data.3.3.Build complete Case Study. Build complete Case Study.
Stage 1:Stage 1:Stage 1:Stage 1:CT AssessmentCT AssessmentCT AssessmentCT Assessment
1.1.Load Case Study.Load Case Study.2.2.Set up graphical tools.Set up graphical tools.3.3.Perform virtual-guided bronchoscopy.Perform virtual-guided bronchoscopy.
1.1.Load Case Study.Load Case Study.2.2.Set up graphical tools.Set up graphical tools.3.3.Perform virtual-guided bronchoscopy.Perform virtual-guided bronchoscopy.
Stage 2:Stage 2:Stage 2:Stage 2:BronchoscopyBronchoscopyBronchoscopyBronchoscopy
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a.a. Build Case Study registry Build Case Study registry a.a. Build Case Study registry Build Case Study registry BB BB
Create CaseCreate Case Create CaseCreate Case
b.b. Set up for computing guidance data Set up for computing guidance data b.b. Set up for computing guidance data Set up for computing guidance data SS SS
Set upSet up Set upSet up
1.1. Create new Case Study.Create new Case Study.1.1. Create new Case Study.Create new Case Study.
2.2. Automatically Automatically compute compute guidance data.guidance data.
2.2. Automatically Automatically compute compute guidance data.guidance data.
3.3. Build complete Build complete Case Study. Case Study.
3.3. Build complete Build complete Case Study. Case Study.
AA AA
BB BB
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DetermDetermine ine
global global 3D 3D
interior interior detail detail
DetermDetermine ine
global global 3D 3D
interior interior detail detail
Travel Travel through through virtual virtual airway airway paths.paths.
Travel Travel through through virtual virtual airway airway paths.paths.
View View structurstructur
e e relations relations
within within their their
environenvironment. ment.
View View structurstructur
e e relations relations
within within their their
environenvironment. ment.
Study Study interior interior
path path dynamidynami
cs.cs.
Study Study interior interior
path path dynamidynami
cs.cs.
Extract Extract paths paths
through through airways.airways.
Extract Extract paths paths
through through airways.airways.
Render Render airway airway
tree with tree with paths, paths,
traverse traverse pathwaypathway
s.s.
Render Render airway airway
tree with tree with paths, paths,
traverse traverse pathwaypathway
s.s.
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Patient underwentPatient underwent EBCT scan (Electron Beam):EBCT scan (Electron Beam):
•single 20-sec breath-holdsingle 20-sec breath-hold•133 contiguous slices 133 contiguous slices
Reconstructed 3D CT image:Reconstructed 3D CT image:•Slice = 512X512 voxelsSlice = 512X512 voxels•Slice thickness =1.5mmSlice thickness =1.5mm•axial-plane [x-y] resolution = 0.586mm.axial-plane [x-y] resolution = 0.586mm.
Patient underwentPatient underwent EBCT scan (Electron Beam):EBCT scan (Electron Beam):
•single 20-sec breath-holdsingle 20-sec breath-hold•133 contiguous slices 133 contiguous slices
Reconstructed 3D CT image:Reconstructed 3D CT image:•Slice = 512X512 voxelsSlice = 512X512 voxels•Slice thickness =1.5mmSlice thickness =1.5mm•axial-plane [x-y] resolution = 0.586mm.axial-plane [x-y] resolution = 0.586mm.
Virtual Navigator showsVirtual Navigator shows•Characteristics of collapseCharacteristics of collapse•Condition of extended bronchial pathways Condition of extended bronchial pathways
Virtual Navigator showsVirtual Navigator shows•Characteristics of collapseCharacteristics of collapse•Condition of extended bronchial pathways Condition of extended bronchial pathways
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MPR MPR ViewsViewsIndicaIndica
teteGlobal Global
3D3Dpositiopositio
nn
MPR MPR ViewsViewsIndicaIndica
teteGlobal Global
3D3Dpositiopositio
nn
DepthDepth--
weighweightedtedSlab Slab
showsshowsgeomgeometryetry
DepthDepth--
weighweightedtedSlab Slab
showsshowsgeomgeometryetry
Same 3D site focused on by all Same 3D site focused on by all tools. tools. Same 3D site focused on by all Same 3D site focused on by all tools. tools.
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Selected 3D Selected 3D site (BLUE site (BLUE
DOT)DOT)Highlighted Highlighted
ononFive Five
different different tools at tools at once. once.
Selected 3D Selected 3D site (BLUE site (BLUE
DOT)DOT)Highlighted Highlighted
ononFive Five
different different tools at tools at once. once.
Bottom to top view of collapse
Site #99Site #99
Near carina, leaving collapse
Approaching collapse
Site #20
Site #47
Within tracheal collapse
Site #86Leaving trachea
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drop in areadrop in areadrop in areadrop in area
Approaching collapse
Site #20Site #20
Within tracheal collapse
Site #47Site #47
Plot clearly shows section Plot clearly shows section where blockage occurs where blockage occurs
Plot clearly shows section Plot clearly shows section where blockage occurs where blockage occurs
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Pathology documented by Pathology documented by captured Depth-Slab captured Depth-Slab
snapshots.snapshots.
Pathology documented by Pathology documented by captured Depth-Slab captured Depth-Slab
snapshots.snapshots.
Extent of collapse shown in Extent of collapse shown in rendered Airway tree.rendered Airway tree.
Extent of collapse shown in Extent of collapse shown in rendered Airway tree.rendered Airway tree.
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Virtual Navigator showsVirtual Navigator shows•Details of existing stentDetails of existing stent•Basis for intervention analysis Basis for intervention analysis (laser therapy was performed)(laser therapy was performed)
Virtual Navigator showsVirtual Navigator shows•Details of existing stentDetails of existing stent•Basis for intervention analysis Basis for intervention analysis (laser therapy was performed)(laser therapy was performed)
Patient underwentPatient underwent EBCT scan (Electron Beam):EBCT scan (Electron Beam):
•single 20-sec breath-holdsingle 20-sec breath-hold•133 contiguous slices 133 contiguous slices
Reconstructed 3D CT image:Reconstructed 3D CT image:•Slice = 512X512 voxelsSlice = 512X512 voxels•Slice thickness =1.5mmSlice thickness =1.5mm•axial-plane [x-y] resolution = axial-plane [x-y] resolution =
0.586mm.0.586mm.
Patient underwentPatient underwent EBCT scan (Electron Beam):EBCT scan (Electron Beam):
•single 20-sec breath-holdsingle 20-sec breath-hold•133 contiguous slices 133 contiguous slices
Reconstructed 3D CT image:Reconstructed 3D CT image:•Slice = 512X512 voxelsSlice = 512X512 voxels•Slice thickness =1.5mmSlice thickness =1.5mm•axial-plane [x-y] resolution = axial-plane [x-y] resolution =
0.586mm.0.586mm.
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Stent Stent visiblevisibleIn this In this andandother other viewsviews
Stent Stent visiblevisibleIn this In this andandother other viewsviews
Same 3D site focused on by all Same 3D site focused on by all tools. tools. Same 3D site focused on by all Same 3D site focused on by all tools. tools.
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Stent Stent encroachencroach
ing on ing on main main
carinacarina
Stent Stent encroachencroach
ing on ing on main main
carinacarina
3.3. Perform Perform virtual-guided virtual-guided bronchoscopy.bronchoscopy.
3.3. Perform Perform virtual-guided virtual-guided bronchoscopy.bronchoscopy.
2.2. Set up Set up graphical tools.graphical tools.
2.2. Set up Set up graphical tools.graphical tools.
1.1. Load Case Load Case Study. Study.
1.1. Load Case Load Case Study. Study.
LL LL
Load CaseLoad Case Load CaseLoad Case SS SS
Graphical ToolsGraphical Tools Graphical ToolsGraphical Tools PP PP
Virtual GuidanceVirtual Guidance Virtual GuidanceVirtual Guidance
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2.2.LIVE LIVE bronchoscope bronchoscope videovideo
2.2.LIVE LIVE bronchoscope bronchoscope videovideo
Video Match Tool Video Match Tool shows a matched shows a matched point between point between
Video Match Tool Video Match Tool shows a matched shows a matched point between point between
3.3.Corresponding Corresponding videobronchosvideobronchoscopy copy ((ROI ROI superimposed)superimposed)
3.3.Corresponding Corresponding videobronchosvideobronchoscopy copy ((ROI ROI superimposed)superimposed)
Virtual data Virtual data guidesguides
airway traversal.airway traversal.
Virtual data Virtual data guidesguides
airway traversal.airway traversal.
Coronal Projection Coronal Projection shows extracted shows extracted
airway treeairway tree
Coronal Projection Coronal Projection shows extracted shows extracted
airway treeairway tree
1.1. CT rendering of CT rendering of airway region airway region((ROI rendered)ROI rendered)
1.1. CT rendering of CT rendering of airway region airway region((ROI rendered)ROI rendered)
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1.1.PhantoPhantomm
2.2.Animal Animal
3.3.HumaHumann
1.1.PhantoPhantomm
2.2.Animal Animal
3.3.HumaHumann
Rubber Rubber phantomphantomRubber Rubber phantomphantom
Experimental set-Experimental set-up:up: physician was blind to physician was blind to phantomphantom
Experimental set-Experimental set-up:up: physician was blind to physician was blind to phantomphantom
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ExtracteExtracted tree d tree and and
pathspaths
ExtracteExtracted tree d tree and and
pathspaths
MatcheMatched video d video frame frame with with ROIROI
MatcheMatched video d video frame frame with with ROIROI
RegistereRegisteredd
virtualvirtualshotshot
RegistereRegisteredd
virtualvirtualshotshot
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Physician #1 (trial 1)Physician #1 (trial 1) Physician #1 (trial 2)Physician #1 (trial 2) Physician #2Physician #2
Distance (mm)Distance (mm) Time sec.Time sec. Distance (mm)Distance (mm) Time sec.Time sec. Distance (mm)Distance (mm) Time sec.Time sec.
2.182.18 12.61312.613 1.731.73 9.6729.672 2.012.01 10.9110.91
1.091.09 8.8658.865 0.970.97 8.7898.789 0.890.89 5.3255.325
Average biopsy error: 1.98 mm Average biopsy error: 1.98 mm
Average match time: 11.065 sec.Average match time: 11.065 sec.
Average biopsy error: 1.98 mm Average biopsy error: 1.98 mm
Average match time: 11.065 sec.Average match time: 11.065 sec.
AverageAverage
Std DevStd Dev
Distance and time measured to match each ROI target.Distance and time measured to match each ROI target.Distance measured from line extrapolated from the needle direction to metal bead edge.Distance measured from line extrapolated from the needle direction to metal bead edge.Note:Note:
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RegistereRegisteredd
virtual virtual shotshot
RegistereRegisteredd
virtual virtual shotshot
LiveLiveEndoscoEndosco
picpicvideovideo
LiveLiveEndoscoEndosco
picpicvideovideo
MatcheMatched video d video frame frame with with ROIROI
MatcheMatched video d video frame frame with with ROIROI
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Snapshots are misaligned to compensate for Snapshots are misaligned to compensate for differing placement during CT scanning.differing placement during CT scanning.
Note:Note:
Actual siteActual site after guided after guided dye marker placement.dye marker placement.Actual siteActual site after guided after guided dye marker placement.dye marker placement.
Planned sitePlanned site from CT analysis. from CT analysis.Planned sitePlanned site from CT analysis. from CT analysis.
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Bronchoscope Bronchoscope video video
matched to matched to rendered CT rendered CT during live during live procedure.procedure.
Bronchoscope Bronchoscope video video
matched to matched to rendered CT rendered CT during live during live procedure.procedure.
National Center National Center for for Research Research Resources Resources of theof the NIH NIH
(grant RR11800)(grant RR11800)
National Center National Center for for Research Research Resources Resources of theof the NIH NIH
(grant RR11800)(grant RR11800)
Whitaker FoundationWhitaker FoundationWhitaker FoundationWhitaker Foundation
National Cancer Institute National Cancer Institute of theof the NIH NIH (grant CA74325)(grant CA74325)National Cancer Institute National Cancer Institute of theof the NIH NIH (grant CA74325)(grant CA74325)
(End)(End)(End)(End)