Fig. 20.1
Virtual bronchoscopic navigation systems available
20.2 Requirements
- 1.
- 2.
Thin-slice CT images, as recommended by the VBN manufacturer
Slice thickness: ≥1.25 mm
Interval of reconstruction: >0.625 mm
Field of view: bilateral lungs
Scanning range: from the apex to the base of the lung
* Note that loading CT images that include information from the entire lung is necessary to visualize bronchial segments precisely.
20.3 How to Operate a VBN
- 1.
Importing images
Import the CT images into the system. Direct import from the server is possible if connection with picture archiving communication system or other sources, such as CD-ROM and external drives, is available.
- 2.
Setting the target lesion
Preset the target lesion on the CT display (Fig. 20.3). Between the two configurations, the outline target better visualizes the lesion compared with the circle target. However, the circle target should be used for lesions that are poorly demarcated from the surrounding structures, such as the chest wall or those having a small attenuation difference with the background lung (e.g., ground-glass opacity, GGO).
Fig. 20.3
Pre-setting the target lesion. To better visualize the target lesion, use the outline target (right button within the red box). For lesions that are poorly demarcated from the surrounding structures or for ground glass opacity, use the circle target (left button within the red box). When using the circle target configuration, the center and the diameter of the circle should be preset. After pre-setting a lesion, click the virtual bronchoscopy button (yellow arrow)
- 3.
Display of the virtual endoscopic image
LungPoint visualizes the airway and major vessels and automatically renders the route to the target lesion. The virtual endoscopic images are displayed on the left side of the screen, with the direction of the endoscope also shown, whereas the axial, coronal, and sagittal images are displayed on the right side of the screen. By default, a three-dimensional diagram of the visualized airway, major vessels, and preset target lesion is displayed on the lower right hand corner, but this may be switched to the virtual endoscopic images as needed (Fig. 20.4).
