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Developing the bronchoscope of tomorrow

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Image Credit: CVC - IAM Team

A combined group of computer scientists and pulmonologists have created the bronchoscope of the future combining computer vision and videogame technology in Barcelona. Incorporating cutting edge technology to regular bronchoscopes, they have given doctors a tool for improved and more precise diagnosis; and patients a quicker, easier medical intervention.

The project, led by Dr. Debora Gil, senior researcher at the Computer Vision Center, has developed a technology that allows a precise calculus of tracheal stenosis in a record time of 9 seconds. What’s more, it creates a personalized map of the patient’s lungs and thus is able to give extremely precise measurements for bronchi stents.

Medical image had not advanced in bronchoscopy treatments for the last 20 years. Looking around me,  technology in general was advancing at such a fast pace, everywhere! However, I couldn’t see any improvement in my day to day practice. I was determined to change that”, states Dr. Antoni Rosell, pulmonologist at Barcelona’s top University Bellvitge-Idibell Hospital and partner of the project. Dr. Gil understood the surgeons’ needs instantly and acknowledged the challenges: “We had to develop a totally new and revolutionary system, but we weren’t able to introduce new instruments within the operating room, we needed to work with technology doctors were already familiarized with”.

A digital bronchial map

This new, groundbreaking medical device uses computer vision to create a 3D representation of a lung, featuring the respiratory tract, bronchi and bronchioles, with the help of augmented reality. Original images are obtained from computer tomography scans and are turned into a precise virtual respiratory system map created with videogame technology. Furthermore, the software includes a digital representation of a bronchoscope enabling surgeons to prepare the pathway of the bronchoscopy prior to the actual intervention by simulating the interaction between a bronchoscope and the bronchial walls.

Dr. Gil puts it graphically: “Imagine this apparatus”, bronchoscope in hand, “which has a mechanical movement, only upwards and downwards, that’s all it does”. “Imagine”, she repeats, “that you have to memorize the pathway down the trachea, bronchi and bronchioles in order to reach the tumor. To do this relying only on memory is a complex and unnecessary task.  Left, right, up, down, but once you’re in and out, right and forth you’ve forgotten which is up, which is down and where else to go. You literally get lost inside your patient’s lungs!”.

Practicing beforehand is key. The software allows the doctor to mark and practice the pathways inside the patient’s virtual lung, just like a GPS, and, most importantly, to see if the internal route planned is even possible. Bronchioles might be too thin or obstructed hence making the way impossible. “What this means for the patient”, explains Dr. Rosell, “is that it makes the process less painful, quicker and easier. In the long run, it would make hospitals more efficient as bronchoscopies would get easier and quicker”.

Tracheal stenosis calculus in record time

Dr. Carles Sánchez is also part of Dr. Debora Gil’s team, and  is responsible for the software that makes the calculus of tracheal stenosis, a feature deployed in this medical system. Tracheal stenosis is the abnormal narrowing of the central air passageways. Up to now, the percentage narrowing of a patient’s trachea was all left to good old subjectivity. With diagnosis being made by eye, variability was too high. “In our area of especialization“, states Dr. Rosell, “an objective tool for calculus is essential. Not only in diagnosis, but also in the treatment’s follow upIf it is objective, it is reproducible and does not depend on the experience of the operator. Having this data allows us to see if the treatment works is effective, and therefore make proper decisions”, continues Dr. Rosell.

The process of obtaining an experienced ‘artificial’ eye has been cumbersome. The software has been trained to detect stenosis just like a physician would do by processing thousands of images of patients with Tracheal stenosis. Dr. Sanchez designed the algorithms that detect the different narrowing grades, with the delivery of a diagnosis in a record time of only 9 seconds.

Accurate prosthesis

The third application of this technology focuses on the accurate measuring of stents. With the use of augmented reality, measuring the insides of the patient’s lung is easier than ever, producing an extremely accurate calculation of any part of the respiratory system. This allows experts not to miss a single millimeter when creating prosthesis.

Inside our body, 1 mm is a huge distance. By simulating the patient’s lung at a precise scale, we can calculate prosthesis sizes with an incredible accuracy”, appoints by Dr. Rosell, “Each prosthesis is within 1000-2000€ worth, therefore, getting one wrong is costly. A tool such as ours not only can help save money, it will also reduce patient time in surgery, the use of anesthesia, hospital resources, the patient and the doctor’s time, etc.

 The future of bronchoscopy

When asked about the future of bronchoscopy one thing is clear: this technology needs to reach industry. Researchers are now in the lookout for a company  that will deploy these advances in the new generations of bronchoscopes.

Will we see this in hospitals any time soon? Dr. Antoni Rosell sighs, “ten, maybe five years. It all depends on the private sector. The talent is here, the concept is designed and the research has been tested. We have reached our goal as a research group, it is now time for business”.

The Project has been funded by:

 

 

 

 

 

 


In the Media:

Zdnet, 04/04/2017: http://www.zdnet.com/article/how-video-game-tech-ar-and-3d-models-help-these-surgeons-do-their-job/

Barcelona FM (podcast in Catalan): http://www.cvc.uab.es/outreach/wp-content/uploads/2017/01/tall_barcelona_FM.mp3

Carlos Sierra

The author Carlos Sierra