Initiatory use of virtual bronchoscopic navigation software: DirectPath

Abstract

Objective To analyze the effectiveness of DirectPath in reconstructing the threedimensional bronchial tree based on different slice thickness computed tomography images and evaluate the ability of DirectPath in guiding a conventional bronchoscope or an ultrathin bronchoscope to the target peripheral bronchus. Methods 60 patients with solitary pulmonary nodules discovered by chest computed tomography scan were selected. Computed tomography of the chest was performed by 8-row or 64-row multidetector. CT images of 30 patients in 8-row multidetector group were recorded to 1.25 mm slices, and CT images of 30 patients in 64-row multidetector group were recorded to 1.25 mm and 0.625 mm slices respectively. All CT data sets were transferred from CDs into the software which could automatically reconstruct the three-dimensional bronchial tree and simulate the bronchoscopic images of the target bronchus. Data of bronchus generation and minimum diameter of right B1a,right B6a,right B10a of each patients in different slice thickness were collected. Results Three-dimensional bronchial trees and virtual bronchoscopic images were successfully reconstructed in all patients. In slice thickness of 1.25 mm, 64-row multidetector group reconstructed better in three-dimensional bronchial tree compared with 8-row multidetector group(Z=- 2.849,P= 0.004),especially in further bronchus generation of right B1a and right B6a.In 64-row multidetector group,further bronchus generation and smaller diameter bronchi in right B1a,right B6a,right B10a were reconstructed in 0.625 mm slices than those in 1.25 mm slices.But there was no statistical differences in the three-dimensional bronchial tree reconstruction between these two slice thicknesses(Z= - 1.732,P= 0.083).There was also no statistical differences in bronchus generation and minimum diameter among right B1a,right B6a,and right B10a in 1.25 mm slices in 60 patients. The proportion of more than six grades(including six grades)bronchi reconstructed by the software among the three bronchi above was 66.7%, 60.0%,and 65.0% respectively,but 90.0%,90.0%,and 88.3% in 0.625 mm slices in 64-row multidetector group. Conclusions DirectPath can reconstruct better three-dimensional bronchial tree in 0.625 mm slices in 64-row multidetector computed tomography. It can guide a conventional bronchoscope or an ultrathin bronchoscope to the peripheral target bronchus. Key words: Virtual bronchoscopy; Navigation; Peripheral lung bronchus