Augmented reality 3D navigation system for percutaneous CT-guided pulmonary ground-glass opacity biopsies: a comparison with the standard CT-guided technique

Abstract

Background: Augmented reality navigation system for percutaneous computed tomography (CT)-guided pulmonary biopsies has recently been introduced. There are no studies in literature about its use for ground glass lesions biopsies. The aim of this study is to evaluate the effectiveness of an augmented reality infrared navigation system performance on CT-guided percutaneous lung ground glass opacity (GGO) biopsy compared to a standard CT-guided technique.

Methods: A total of 80 patients with lung GGO who underwent to a percutaneous CT-guided lung biopsy with an augmented reality infrared navigation system were retrospectively enrolled in the study. Comparison was performed with a group of 80 patients who underwent to lung biopsy with the standard CT-guided technique. Evaluation of maximum lesion diameter (MLD), distance between lesion and pleural surface (DPS), distance travelled by the needle (DTP), procedural time, validity of histological sample, procedural complications and the radiation dose to the patient's chest were recorded for each patient of both groups. In addition, each group was divided into two subgroups based on lesion size, according to a cut-off of 1.5 cm (<1.5 cm; ≥1.5 cm).

Results: Augmented reality navigation system showed a significant reduction in procedural time, radiation dose administrated to patients and complications rate compared to a standard CT-guided technique. Technical success was achieved in the 100% of cases in both groups, but the diagnostical success was higher in the group where patients underwent to lung biopsies with the use of navigation system. We also found that using an augmented reality navigation system increases the diagnostical success rate for lesion <1.5 cm. MLD, DPS and DTP did not differ significantly between the two groups of patients.

Conclusions: The use of an augmented reality navigation system for percutaneous CT-guided pulmonary GGO biopsies has demonstrated a lower incidence of post-procedural complications, a significantly reduction of the radiation dose administered to patients and a higher diagnostical success rate.

Keywords: Ground glass opacity (GGO); augmented reality navigation system; percutaneous lung biopsy (PLB).

Figure 1

Navigation system elements. CT scanner, elaboration and visualization SIRIO unit and the sensors system (composed by needle sensor, patient’s sensor and photo sensor positioned in the room roof) are shown. CT, computed tomography.

Figure 2

Low dose CT images showing GGO in upper segment of LRL about 13×7 mm in diameter next to the hilum and adherent to the pleural fissure in 84 years old female patient under double antiplatelet therapy. Axial (A) and reformatted axial plane (B) along needle path images showing the correct needle placement into GGO. Final post-PLB CT control (C) showing a self-limited small focus of haemorrhage without PTX. Histological analysis reveals adenocarcinoma. CT, computed tomography; GGO, ground glass opacity; LRL, lower right lobe; PLB, percutaneous lung biopsy; PTX, pneumothorax.

Figure 3

Low dose CT image (A) showing GGO in upper segment of LRL about 14×9 mm in 72 years old man patient with a history of chronic lymphocytic leukemia and prostatic adenocarcinoma. Axial MPR (B) and sagittal MIP reconstruction (C) images along needle track. Histological analysis was adenocarcinoma. CT, computed tomography; GGO, ground glass opacity; LRL, lower right lobe; MPR, multiplanar reconstruction; MIP, maximum intensity projection.

Figure 4

Boxplots show not significantly differences between the trial and the control groups for MLD (A), DPS (B) and DTP (C), while a significantly lower PT was reported in patients who had lung biopsy CT guided using SIRIO (D). In addition, we demonstrated that the radiation effective dose to the patient’s chest was significantly decreased in patients of the trial group (E). MLD, maximum lesion diameter; DPS, distance between lesion and pleural surface; DTP, distance travelled by the needle; PT, procedure timing; CT, computed tomography.