Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy

Michael A Pritchett; Krish Bhadra; Mike Calcutt; Erik Folch

doi:10.21037/jtd.2020.01.35

Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy

J Thorac Dis. 2020 Apr;12(4):1595-1611. doi: 10.21037/jtd.2020.01.35.

Authors

Michael A Pritchett¹, Krish Bhadra², Mike Calcutt³, Erik Folch⁴

Affiliations

¹ FirstHealth of the Carolinas and Pinehurst Medical Clinic, Pinehurst, NC, USA.
² CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN, USA.
³ Clinical Education, Medtronic, Minneapolis, MN, USA.
⁴ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

Guided bronchoscopy offers a minimally invasive and safe method for accessing indeterminate pulmonary nodules. However, all current guided bronchoscopy systems rely on a preprocedural computed tomography (CT) scan to create a virtual map of the patient's airways. Changes in lung anatomy between the preprocedural CT scan and the bronchoscopy procedure can lead to a divergence between the expected and actual location of the target lesion. Termed "CT-to-body divergence", this effect reduces diagnostic yield, adds time to the procedure, and can be challenging for the operator. The objective of this paper is to describe the concept of CT-to-body divergence, its contributing factors, and methods and technologies that might minimize its deleterious effects on diagnostic yield.

Keywords: Bronchoscopy; X-ray computed; lung neoplasms; movement; respiratory-gated imaging techniques; tomography.

Publication types

Editorial