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The Department would like to recognize Associate Professor of Radiology Yueh Z. Lee, MD, PhD, for receiving in September 2019 $2.8M+ National Institute of Biomedical Imaging and Bioengineering (NIBIB) R01 funding over four years as P.I. of an academic-industrial partnering study, entitled, “Stationary Digital Tomosynthesis for Transbronchial Biopsy Guidance.” As expanding lung cancer screening programs drive rising numbers in lung lesion detection, this study addresses the need for next-stage development of a more optimal approach to lung nodule localization.

Over the study period (9/15/19-5/31/23), Lee’s collaborative team of basic scientists and clinical research physicians, physicists (UNC) and software scientists (UNC & Kitware ) aims to improve upon low to moderate diagnostic yields produced by other approaches to peripheral nodule biopsy, through refining a novel intraoperative chest tomosynthesis (iDCT) system for early-stage, pre-clinical investigation.

To date, modalities used for imaging-guided intraoperative bronchoscopy all have demonstrated drawbacks limiting their long-term use in interventional pulmonology for early-stage lung cancer diagnosis and screening. Bronchoscopy and biopsy offer the lowest procedural complications, yet generate moderate diagnostic yields (70%). Other standard modalities used for lung nodule localization have a spectrum of major drawbacks, including: 1) Lack of real-time image confirmation of the lesion at time of biopsy – Radial endobronchial ultrasound (r-EBUS); 2) Poor target lesion visualization – Single-plane and bi-plane fluoroscopy projection x-rays; 3) High radiation dose and expense – Standard CT; and 4) Cumbersome X-ray source and detector crowding procedural space, disadvantaging patient care – (investigative) Cone-beam CT (CBCT).

The most promising pre-clinical studies for applying real-time visualization to biopsy tools during localization suggest combining electronic navigation bronchoscopy (EMN-B) with intraoperative imaging biopsy. However, using EMN-B presents challenges such as limited virtual imaging guidance, lack of respiratory gating, compromised bronchoscope reach and loss of localization guidance during biopsy.

Over the study period, researchers will develop and evaluate 3D visualization software in a pre-clinical, simulated interventional pulmonology procedural workflow. Lee’s team will specifically optimize stationary chest tomosynthesis imaging protocols, evaluate rapid CT to tomosynthesis image registration techniques, and integrate the software control and guidance system within a system for pre-clinical large animal evaluation.

The UNC-Kitware collaborative team of physicists, computer scientists, radiologists and interventional pulmonologists seeks to overcome challenges associated with currently used modalities through refining a stationary iDCT system based on the linear x-ray array invented at UNC based on carbon nanotube field emission.  Its lack of source or detector motion overcomes the challenges of thoracic cavity physical motion with other imaging guided-approaches to bronchoscopy, including limited diagnostic sensitivity, tumor movement, poor resolution and other intraprocedural hindrances. The imaging and bronchoscope guidance can be performed without the need for any motion of the imaging hardware, unlike conventional c-arms or fluoroscopy suites.

If advanced to long-term clinical utility, this refined system would equip interventional pulmonologists and other interventionalists with an unprecedented stereoscopic instrumentation for imaging-guided bronchoscopy in peripheral nodule biopsy. An intraoperative bronchoscopy tool with superior diagnostic yields to other modalities would in the long-term improve earlier-stage, more effective and safer lung cancer diagnosis and reduced morbidity in lung cancer and patient screening.