Augmented reality navigation-guided pulmonary nodule localization in a canine model

Abstract

Background: The current intraoperative pulmonary nodule localization techniques require specific medical equipment or skillful operators, which limits their widespread application. Here, we present an innovative nodule localization technique in a canine lung model using augmented reality (AR) navigation.

Methods: Peripheral pulmonary lesions were artificially created in canine model. A preoperative chest computed tomography scan was performed for each animal. The acquired computed tomography images were analyzed, and an established intraoperative localization plan was uploaded into HoloLens (a head-mounted AR device). Under general anesthesia, lung localization markers were implanted in each canine, guided by the established procedure plan displayed by HoloLens. All artificial lesions and markers were removed by video-assisted wedge resection or lobectomy in a single operation.

Results: Since June 2019, 12 peripheral pulmonary lesions were artificially created in 4 canine models. All lung localization markers were precisely implanted with a median registration and implantation time of 6 minutes (range, 2-15 minutes). The average distance between pulmonary lesions and markers was 1.9±1.7 mm, based on computed tomography examination after localization. No severe pneumothorax was observed after marker implantation. After an average implantation period of 16.5 days, no marker displacement was observed.

Conclusions: The AR navigation-guided pulmonary nodule localization technique was safe and effective in a canine model. The validity and feasibility of using this technology in patients will be examined further (NCT04211051).

Keywords: Augmented reality (AR); animal study; intraoperative nodule localization; navigation.

Figure 1

Lungbrella marker device set. The device set includes the following three major components. (A) Puncture needle with 3D-trackable QR code-like pattern; (B) nitinol braided marker; (C) putter. The marker is pre-loaded inside the puncture needle and extruded by the putter after the needle has reached the desired release location. QR code, quick response code.

Figure 2

Skin marker. The skin marker consists of a transparent skin dressing and CT-visible copper markers, with holes in their centers, covered with strength paper to facilitate the taping procedure. The distance between two consecutive copper markers is 2 cm. CT, computed tomography.

Figure 3

Positioning QR code. A board with a printed QR code, together with green head/feet direction indication letters (in Chinese). This board will be placed beside the operating area before navigation start. QR code, quick response code.

Figure 4

HoloLens navigation-guided puncture. The operator (Author Chengqiang Li) inserting the second needle into the animal’s lung under HoloLens guidance. The animal was under general anesthesia in the supine position.

Video 1

Procedure of augmented reality navigation-guided pulmonary nodule localization.

Figure 5

Post-marker implantation procedures (marker ID 12). After each marker implantation, a CT scan was performed to verify its immediate distance from the artificial lesion. After three markers were implanted, the VATS procedure was executed to evaluate each marker’s anchoring status within the lung tissue. All three implanted markers were resected by wedge resection or lobectomy procedures to determine the actual relative positions of the marker and the artificial lesion. (A) Reconstructed CT image showing the artificial lesion and the implanted marker; (B) pulling the tail of the marker during the VATS operation; (C) sliced tissue sample after wedge resection. CT, computed tomography; VATS, video-assisted thoracoscopic surgery.

Figure 6

Estimated workflow of the AR navigation-guided nodule localization. AR, augmented reality; CT, computed tomography.