Chest
Volume 109, Issue 2, February 1996, Pages 549-553
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Preliminary Report
Virtual Bronchoscopy: Relationships of Virtual Reality Endobronchial Simulations to Actual Bronchoscopic Findings

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Advances in computer technology have permitted development of virtual reality images of the tracheobronchial tree using data sets derived from helical CT of the chest. To determine the relevance of these images to actual bronchoscopic findings, we compared “virtual bronchoscopy” images with videotaped bronchoscopy results in 20 patients who had undergone both helical chest CT and fiberoptic bronchoscopy during clinical evaluation of their thoracic problems. Suboptimal endobronchial simulations in ten patients identified important, readily-addressed technical requirements for this imaging procedure. In the ten patients with technically suitable renderings of the airway, virtual bronchoscopy simulations accurately demonstrated endobronchial obstructions by tumor in five, airway distortion and/or ectasia in four, and accessory bronchi in another. These preliminary observations suggest that virtual bronchoscopy simulations accurately represent major endobronchial anatomic findings. This technique may have a role in prebronchoscopy planning, endoscopy training, and/or endobronchial therapy, and merits further study.

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METHODS

Virtual bronchoscopy images were derived from helical CT of the chest performed for clinical indications in 20 patients. Helical CT was performed with a CT scanner (GE HiSpeed Advantage CT scanner, GE Medical Systems, Milwaukee, Wisc) during a single breath-hold acquisition. Scanning parameters consisted of 3 mm x-ray beam collimation (slice thickness), 6 mm/s table speed, and 1 mm reconstruction intervals. CT images were then transferred from the scanner to a computer workstation (Silicon

RESULTS

Virtual bronchoscopy images were developed in 20 patients. CT data sets from ten patients were suboptimal because of respiratory and cardiac motion which degraded the 3D reconstructions and occasionally due to inappropriately thick CT slices. Although airway simulations could be created in the ten suboptimal cases, these did not accurately reproduce the details of airway anatomy because of “stairstepping” artifacts. The importance of coaching a patient with breathing instructions was

DISCUSSION

“Virtual bronchoscopy” tracheobronchial images can be derived successfully using helical CT images of the chest with remarkable simulation of major endobronchial abnormalities confirmed at fiberoptic bronchoscopy. The predictions of airway patency compared to bronchoscopy in patients with lung cancer have been evaluated previously. Colice et al,6 Naidich and colleagues,7 and others8, 9, 10, 11, 12, 13, 14, 15, 16 have noted that CT had high positive and negative predictive values for detection

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Presented in part at the 1994 Annual Meetings of the American Thoracic Society, Boston, May 24, 1994, and American College of Chest Physicians, New Orleans, Nov 1, 1994.

Supported by a Developmental Technology Grant from the North Carolina Baptist Hospital

revision accepted August 30.

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