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. 2023 Aug 30;12(8):1728-1737.
doi: 10.21037/tlcr-23-201. Epub 2023 Aug 4.

Augmented reality navigation-guided intraoperative pulmonary nodule localization: a pilot study

Chengqiang Li #  1 , Anqi Ji #  2 , Zheng Jian #  3 , Yuyan Zheng #  1 , Xijia Feng  1 , Wei Guo  1 , Toni Lerut  4 , Jules Lin  5 , Hecheng Li  1
Affiliations

Augmented reality navigation-guided intraoperative pulmonary nodule localization: a pilot study

Chengqiang Li et al. Transl Lung Cancer Res. .

Abstract

Background: With the increasing number of small pulmonary nodules detected, effective localization of pulmonary nodules has become an issue. The goal of this study is to determine the safety and feasibility of a newly developed augmented reality navigation technology for intraoperative localization of small pulmonary nodules.

Methods: We conducted a prospective single-center feasibility study of a novel augmented reality navigation system and lung localization (LungBrella) marker on ten patients between July and October 2020. For augmented reality navigation-guided localization, a preoperative chest computed tomography scan was performed to generate 3-dimensional (3D) virtual images and individualized localization plan, which were uploaded into Hololens (a head-mounted augmented reality device). Under the guidance of established procedure plan displayed by HoloLens, localization marker was placed in operating room. Segmentectomy or wedge resection was subsequently performed. The primary endpoint was the localization procedure success rate, and the secondary endpoints were localization time, operation time, and complications.

Results: Localization was successful in seven of the ten procedures. Due to different reasons, failures were noted in three cases, after which immediate adjustments were made. In the successful cases, the LungBrella marker was positioned at a median of 5.8 mm (range, 0-10 mm) from the edge of the nodule. Median localization time was 9.4 min (range, 5-19 min), and median operation time was 172.9 min (range, 105-200 min). There were no complications during the entire process.

Conclusions: This exploratory study suggests that augmented reality navigation-guided pulmonary nodule localization is a safe and feasible technique (ClinicalTrials.gov identifier, NCT04211051).

Keywords: Small pulmonary nodules; augmented reality; intraoperative localization.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-201/coif). JL declared collaboration with Jedicare Medical Co., Ltd. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Design of the study. We designed an augmented reality navigation-guided localization technique for pulmonary nodules and evaluated its safety and feasibility in 10 patients (with a total of 10 nodules).
Figure 2
Figure 2
AR navigation system and lung localization marker. (A) The AR navigation system consisting of a Hololens computer and a personal computer with preloaded JediVision software. (B) Positioning tapes are attached in the middle and on the lesion side of the chest. Positioning QR codes are used in the patient registration stage during AR navigation. (C) LungBrella marker system consisting of a localization marker, puncture needle, and pusher (top to bottom). The handle of the puncture needle is a 3D pattern recognizable by the JediVision software in the Hololens computer. The marker is preloaded inside the needle before usage. After reaching the target, the marker is pushed from the needle by the pusher. (D) A position board is used to ensure consistency between the patient’s position during the preoperative computed tomography scanning and the time of the navigational puncture. AR, augmented reality; QR, quick-response.
Figure 3
Figure 3
The basic procedures for patients undergoing pulmonary nodule localization. (A) The CT demonstrates the pulmonary nodule. (B) CT data are loaded into the JediVision software, which is used to determine the expected anchor position of the marker and the skin entry point of the transthoracic puncture. (C) The LungBrella needle reaches the expected anchor position. (D) The pulmonary nodule is found using the LungBrella marker. CT, computed tomography.
Figure 4
Figure 4
Placement of the localization marker. (A) Deployment of the localization marker in the lung parenchyma. (B) View seen by the operator during the augmented reality-guided pulmonary nodule localization procedure. The green circle represented a precise trackable region. When the 3D code (pattern for tracking) is within this circle, the tracking accuracy would be guaranteed. 3D, three-dimensional.
Video 1
Video 1
Procedure of localization of pulmonary nodules and surgery.
See this image and copyright information in PMC

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References

    1. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med 2020;382:503-13. 10.1056/NEJMoa1911793 - DOI - PubMed
    1. National Lung Screening Trial Research Team ; Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409. 10.1056/NEJMoa1102873 - DOI - PMC - PubMed
    1. Gould MK, Tang T, Liu IL, et al. Recent Trends in the Identification of Incidental Pulmonary Nodules. Am J Respir Crit Care Med 2015;192:1208-14. 10.1164/rccm.201505-0990OC - DOI - PubMed
    1. Li N, Tan F, Chen W, et al. One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study. Lancet Respir Med 2022;10:378-91. 10.1016/S2213-2600(21)00560-9 - DOI - PubMed
    1. Tamura M, Oda M, Fujimori H, et al. New indication for preoperative marking of small peripheral pulmonary nodules in thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2010;11:590-3. 10.1510/icvts.2010.241018 - DOI - PubMed

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