Advanced Imaging for Robotic Bronchoscopy: A Review

Area of Science:

• Pulmonology
• Medical Imaging
• Interventional Bronchoscopy

Background:

• Advancements in navigational platforms like electromagnetic navigation and robotic bronchoscopy have improved lung lesion diagnosis.
• Despite technological progress, diagnostic yields often lag behind transthoracic computed tomography (CT) guided needle biopsy.
• CT-to-body divergence remains a significant limitation in current bronchoscopic interventions.

Purpose of the Study:

• To review the role of adjunct imaging in robotic bronchoscopy for diagnosing pulmonary lesions.
• To discuss strategies for mitigating CT-to-body divergence.
• To explore the potential of advanced imaging in lung tumor ablation.

Main Methods:

• Review of recent literature on robotic bronchoscopy and advanced imaging techniques.
• Discussion of CT-to-body divergence and its impact on diagnostic yield.
• Exploration of adjunct imaging modalities including radial endobronchial ultrasound, tomosynthesis, cone-beam CT, and O-arm CT.

Main Results:

• Adjunct imaging provides crucial real-time feedback, improving the tool-lesion relationship during robotic bronchoscopy.
• Advanced imaging modalities can help overcome the CT-to-body divergence phenomenon.
• These techniques hold promise for enhancing diagnostic accuracy and enabling lung tumor ablation.

Conclusions:

• Integrating advanced imaging with robotic bronchoscopy is essential for improving diagnostic yield in peripheral pulmonary lesions.
• Strategies to counteract CT-to-body divergence are critical for effective intervention.
• Advanced imaging shows potential for expanding the role of bronchoscopy in lung cancer management, including ablation.