Background: Flexible bronchoscopy is routinely utilized in the diagnosis and treatment of various lung diseases. Nondiagnostic bronchoscopy leads to more invasive interventions, such as transthoracic needle aspiration, mediastinoscopy or even thoracotomy. Electromagnetic navigation is a novel technology that facilitates approaching peripheral lung lesions, which are difficult to sample by conventional means. The navigation system involves creating an electromagnetic field around the chest and localizing an endoscopic tool using a microsensor overlaid upon previously acquired CT images. Objectives: To determine the practicality, accuracy and safety of real-time electromagnetic navigation, coupled with previously acquired 3D CT images, in locating artificially created peripheral lung lesions in a swine model. Methods: Peripheral lung lesions were created in four swine models by insertion of a metal tube (1 × 10 mm) via a transthoracic approach. An electromagnetic field was created by placing the animal on an electromagnetic location board. A position sensor incorporated into the distal tip of a dedicated tool was used to navigate to the various target lesions. Information gathered in real time during bronchoscopy was presented on a monitor simultaneously by displaying previously acquired CT images. Upon reaching the target lesion, biopsies were performed and the functionality and safety of the superDimension/Bronchus System was observed and documented. Results: The registration accuracy expressed by the fiducial target registration error, expressing both the registration quality and the stability of fiducial (registration) points, was 4.5 mm on average. No adverse effects, such as pneumothorax or internal bleeding, were encountered in any of the animals in this study. Conclusions: Real-time electromagnetic positioning technology coupled with previously acquired CT images is an accurate technology added to standard bronchoscopy to assist in reaching peripheral lung lesions and performing biopsies.

Keywords:
Animal trial, Biopsy, peripheral lung lesion, Bronchoscopy, CT-guided, Virtual bronchoscopy, Electromagnetic navigation
1.
Stoller JK, Ahmad M, Rice TW: Solitary pulmonary nodule. Cleve Clin J Med 1988;55:68–74.
2.
Healthcare Cost and Utilization Project. Rockville, Agency for Healthcare Research and Quality, 2001.
3.
Wallace JM, Deutsch AL: Flexible fiber-optic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule. Chest 1982;81:665–667.
4.
Gay PC, Brutinel WM: Transbronchial needle aspiration in the practice of bronchoscopy. Mayo Clin Proc 1989;64:158–162.
5.
Reichenberger F, Weber J, Tamm M, Bolliger CT, Dalquen P, Perruchoud AP, Soler M: The value of transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. Chest 1999;116:704–708.
6.
Westcott JL, Rao N, Colley DP: Transthoracic needle biopsy of small pulmonary nodules. Radiology 1997;202:97–103.
7.
Lopez Hanninen E, Vogl TJ, Ricke J, Felix R: CT-guided percutaneous core biopsies of pulmonary lesions. Diagnostic accuracy, complications and therapeutic impact. Acta Radiol 2001;42:151–155.
8.
Hirose T, Mori K, Machida S, Tominaga K, Yokoi K, Adachi M: Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules. Jpn J Clin Oncol 2000;30:259–262.
9.
Hoffmann H, Dienemann H: Der pulmonale Rungherd. Prinzipien der Diagnostik. Dtsch Ärztebl 2000;97:B-907–B-912.
10.
Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM, Aughenbaugh GL, Clemens MA: Lung cancer screening with CT: Mayo Clinic experience. Radiology 2003;226:756–761.
11.
Radke JR, Conway WA, Eyler WR, Kvale PA: Diagnostic accuracy in peripheral lung lesions. Factors predicting success with flexible fiberoptic bronchoscopy. Chest 1979;76:176–179.
12.
Baaklini WA, Reinoso MA, Gorin AB, Sharafkaneh A, Manian P: Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest 2000;117:1049–1054.
13.
Solomon SB, White P Jr, Acker DE, Strandberg J, Venbrux AC: Real-time bronchoscope tip localization enables three-dimensional CT image guidance for transbronchial needle aspiration in swine. Chest 1998;114:1405–1410.
© 2003 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.