Vi har utviklet Fraxinus, et enkelt verktøy for planlegging av bronkoskopi. Vi planlegger nå første kliniske studie, hvor vi vil legge mest vekt på brukbarhet, pasientsikkerhet og din vurdering av nytte, men vi vil også studere diagnostisk utbytte og prosedyretid sammenliknet med ordinær bronkoskopi. Vi planlegger en fler-senterstudie, der sykehus i alle helseregioner i Norge deltar.
Vi har som mål å starte opp første halvår 2017, med opplæring og utplassering, og begynne pasientutprøving rundt neste sommer. Vi har ennå ikke full finansiering av utprøvingen, så endelig oppstart er ikke bestemt. Vi er likevel takknemmelige for et svar om interesse.
Vi har utviklet Fraxinus, et enkelt verktøy for planlegging av bronkoskopi. Det er laget for å vise vei gjennom luftveiene ut til perifere lungesvulster.
Hvordan virker Fraxinus?
Fraxinus bruker pasientens CT som materiale. Fraxinus genererer nye og mer avanserte presentasjoner enn vi vanligvis finner i sykehusenes PACS-systemer. Brukeren markerer tumoren som skal biopseres, og så finner Fraxinus den raskeste ruten dit gjennom luftveiene. Den viktigste presentasjonen er virtuell bronkoskopi, som er er en imitasjon av vanlig bronkoskopivideo. Inne i denne virtuelle bronkoskopien legges en linje som viser veien fra trachea, gjennom bronkie-treet fram til tumor.
Om dagens Fraxinus
Fraxinus er under kontinuerlig utvikling, men er ikke endelig ferdig og gjennomtestet. Det er ikke medisinsk godkjent, og er derfor å regne som et forskningsverktøy. Dette innebærer at brukerne må vise skjønn, og selv ta ansvar for resultatene Fraxinus produserer.
Hva kreves for å kjøre Fraxinus på egen maskin?
Vi ønsker at Fraxinus skal kunne kjøres på vanlige datamaskiner, og har versjoner for Mac, Windows og Linux. Vi har dessverre et begrenset utvalg av datamaskiner hos oss for å teste om det faktisk virker. Våre utviklingsmaskiner er forholdsvis kraftige maskiner med kraftige grafikkkort, stort sett MacBook Pro og Linux-maskiner. Men vi har også testet Fraxinus på enklere Windows-bærbare.
Vi samler nå informasjon om maskiner som klarer å kjøre Fraxinus, og er svært takknemmelige for tilbakemeldinger om deres erfaringer med forskjellige maskiner.
An open source, software only, navigation system for bronchoscopy.
Bronchoscopy is the endobronchial procedure for inspection and diagnostic sampling in the airways, e.g. to diagnose lung cancer. Navigating the flexible bronchoscope through the airways to the target for the diagnostic sampling, like biopsy or fine needle aspiration, is challenging due to the numerous divisions of the airways tree structure and the lack of direct visibility of smaller peripheral lesions. Even with fluoroscopy guidance, the diagnostic success rate for bronchoscopically non-visible tumors is as low as 15% compared to 80% for visible tumors, dependent on tumor size, the doctors experience and the method used for sampling[1-3]. Using navigated bronchoscopy is a possibility to reduce these challenges and thus increase the biopsy success rate.
DISCLAIMER: Fraxinus is a research tool: It is not intended for normal clinical use, and is not FDA nor CE approved.
Fraxinusis free.
Fraxinusis technically a front end, containing all open source code and abilities of CustusX, but with a simplified and streamlined interface adapted to bronchoscopy procedures, planning and guidance.
Fraxinushas a user interface customized to the different phases of bronchoscopy planning: Import of CT Thorax images in DICOM format, target pinpointing, automatic anatomical segmentation of airways, and navigation. The navigation screen contains virtual bronchoscopy, 3D models of airways, and cross-sectional slices of the chest CT. For the target navigation, the system generates a route to the target, and the user navigates along this route using a mouse or keyboard. Fraxinus contains no real-time position tracking of bronchoscope or tools.
The algorithm for airway segmentation has been tested and the results have been published [4], the data used to test the algorithm is available to be downloaded here.
To import Mhd datasets:
Start Fraxinus
Create new patient
Select File -> Import data (instead of importing DICOM)
<follow normal usage>
Phantom data
CT Dicom data for EBUS Phantom - Ultrasonic Bronchoscopy Simulator LM-099 307 (KOKEN CO., LTD, Tokyo, Japan) can be downloaded here.
1. W. A. Baaklini, M. A. Reinoso, A. B. Gorin, A. Sharafkaneh, and P. Manian. Diagnosticyield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules.CHESTJournal, 117(4):1049–1054, 2000
2. G. Schreiber and D. C. McCrory. Performance characteristics of different modalities fordiagnosis of suspected lung cancer: summary of published evidence.Chest journal, 123(1suppl):115S–128S, 2003
3. R. Yung. Tissue diagnosis of suspected lung cancer: selecting between bronchoscopy,transthoracic needle aspiration, and resectional biopsy.Respiratory care clinics of NorthAmerica, 9(1):51–76, 2003.
CustusX is a Navigation System for Image-Guided Intervention. The intended audience is clinical and technological researchers in the fields of medical imaging and navigation. The platform can be used both as a customizable navigation system and as a toolkit for developing new applications. The main focus of CustusX is the use of intraoperative Ultrasound.
Image-Guided Therapy
Image Guided Therapy are minimal invasive procedures where the operator makes extensive use of images for guiding the treatment/intervention. These procedures require highly accurate and updated images of the relevant anatomy. Pre-operative modalities like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) have traditionally been used, but in recent years modalities like Functional MRI (FMRI), Positron Emission Tomography (PET) and ultrasound are getting more attention.
For updated image data, ultrasound, X-Ray/fluoroscopy or cone-beam CT can be visualised together with the pre-operative images. During interventional procedures, the position and pose of instruments inside the body are tracked in real-time and visualised at correct location within the image data, forming a navigation system.
CustusX is the software component connecting the images, tracked surgical instruments and the computer display in order to create a complete navigation system. It contains a toolbox of navigation features, image-processing algorithms, connections to external hardware and other functionality useful for working with IGT.
Use in Research
The system can be used to perform clinical studies requiring an IGT platform. It can also be customized to create new applications that specializes on a particular procedure/field, enabling testing and research on novel imaging techniques. CustusX can be used without any restrictions, as it is available under a BSD-license. CustusX is indended for research only, and is not approved for routine clinical use in any way. Before use in a clinical research setting, the necessary approvals according to safety regulations etc. must be obtained by the end user.
