The purpose of this chapter is to review the role of virtual bronchoscopy and 3-D imaging of the airways in clinical practice.
Virtual bronchoscopy generates high-definition tracheobronchial tree pictures and endobronchial views which mimic traditional bronchoscopy.
Patient preparation for surgical intervention takes time and effort and for the anaesthetist the most important is airway assessment.
Virtual bronchoscopy (VB) is an animated 3-D CT post-processing practice that generates high-definition tracheobronchial tree photos and endobronchial views that mimic standard bronchoscopy reports. The most important limitations of fibre-optic bronchoscopy being inability to advance beyond the 4–5 (dichotomous) division and its invasiveness on high-risk patients raised a strain to figure out a non-invasive technique.
Inhalational injury produces mucosal changes that can’t be easily detected by ordinary CT in the acute phase of injury when there is no airway narrowing or obstruction. Evaluation of how reliable is multi-detector computed tomography (VB) to detect such injury is a new emerging modality in this field.
Also VB is utilized as a quick guide for transbronchial needle aspiration biopsy. It provides higher assurance in the examination of little nodes and nodes in very difficult places; in addition it reduces technique moment.
Virtual bronchoscopic navigation had been used before closing the endobronchial fistula in postoperative bronchopleural fistula. VB is an important diagnostic screening tool in postoperative lung transplantation patients to diagnose any airflow obstruction by using the correlation between VB and pulmonary functions tests.
Data sets from MDCT that are used for VB can also be used to obtain volumetric data that can be utilized to produce in vivo airway casts and anatomic 3D models that can be used for 3D printing.
This is a preview of subscription content, log in to check access.
Virtual bronchoscopy and VRT movies as a non-invasive method that allows accurate grading of tracheobronchial stenosis (AVI 28903 kb)
MDCT scan reveals absent left lung, obliterated left main bronchus with nippling, absent left pulmonary artery and significant hyperinflation of the right lung crossing to the left through the anterior mediastinum (AVI 6050 kb)
MDCT scan reveals absent left lung, obliterated left main bronchus with nippling, absent left pulmonary artery and significant hyperinflation of the right lung crossing to the left through the anterior mediastinum (AVI 21999 kb)
MDCT scan reveals absent left lung, obliterated left main bronchus with nippling, absent left pulmonary artery and significant hyperinflation of the right lung crossing to the left through the anterior mediastinum (AVI 2319 kb)
MDCT scan reveals absent left lung, obliterated left main bronchus with nippling, absent left pulmonary artery and significant hyperinflation of the right lung crossing to the left through the anterior mediastinum (AVI 9459 kb)
Honnef D, Wildberger JE, Das M, et al. Value of virtual trachea-bronchoscopy and bronchography from 16-slice multidetector-row helical CT for assessment of suspected tracheobronchial stenosis in children. Eur Radiol. 2006;16:1684–91.CrossRefGoogle Scholar
Fetita CI, Preteux F, Beigelman-Aubry C, Grenier P. Pulmonary airways: 3-D reconstruction from MDCT and clinical investigation. IEEE Trans Med Imaging. 2004;23:1353–64.CrossRefGoogle Scholar
Adamczyk M, Tomaszewski G, Naumczyk P, Kluczewska E, Walecki J. Usefulness of computed tomography virtual bronchoscopy in the evaluation of bronchi divisions. Pol J Radiol. 2013;78(1):30–41.CrossRefGoogle Scholar
Kwon HP, Zanders TB, Regn DD, Burkett SE, Batchinsky AI. Comparison of virtual bronchoscopy to fiber-optic bronchoscopy for assessment of inhalation injury severity. Burns. 2014;40(7):1308–15.CrossRefGoogle Scholar
Englmeier KH, Seemann MD. Multimodal virtual bronchoscopy using PET/CT images. Comput Aided Surg Mar. 2008;13(2):106–13.CrossRefGoogle Scholar
Hoppe H, Dinkel HP, Walder B, von Allmen G, Gugger M, Vock P. Grading airway stenosis down to the segmental level using virtual bronchoscopy. Chest. 2004;125:704–11.CrossRefGoogle Scholar
Koşucu P, Ahmetoğlu A, Koramaz I, Orhan F, Özdemir O, Dinç H, Ökten A, Gümele HR. Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration. Am J Roentgenol. 2004;183:1771–7.CrossRefGoogle Scholar
Finkelstein SE, Summers RM, Nguyen DM, Stewart JH, Tretler JA, Schrump DS. Virtual bronchoscopy for evaluation of malignant tumors of the thorax. J Thorac Cardiovasc Surg. 2002;123:967–72.CrossRefGoogle Scholar
Walker PF, Buehner MF, Wood LA, Boyer NL, Driscoll IR, Lundy JB, Cancio LC, Chung KK. Diagnosis and management of inhalation injury: an updated review. Crit Care. 2015;19:351.CrossRefGoogle Scholar
Gore MA, Joshi AR, Nagarajan G, Iyer SP, Kulkarni T, Khandelwal A. Virtual bronchoscopy for diagnosis of inhalation injury in burnt patients. Burns. 2004;30(2):165–8.CrossRefGoogle Scholar
Finkelstein SE, Schrump DS, Nguven DM, Hewitt SM, Kunsl TF, Summers RM. Comparative evaluation of super high-resolution CT scan and virtual bronchoscopy for the detection of tracheobronchial malignancies. Chest. 2003;124:1834–40.CrossRefGoogle Scholar
Liewald F, Lang G, Fleiter T, Sokiranski R, Halter G, Orend KH. Comparison of virtual and fiberoptic bronchoscopy. Thorac Cardiovasc Surg. 1998;46:361–4.CrossRefGoogle Scholar
Moriwaki Y, Sugiyama M, Matsuda G, et al. Usefulness of the 3-D-tracheography. World J Surg. 2005;29:102–5.CrossRefGoogle Scholar
McAdams HP, Goodman PC, Kussin P. Virtual bronchoscopy for directing transbronchial needle aspiration of hilar and mediastinal lymph nodes: a pilot study. AJR. 1998;170:1361–4.CrossRefGoogle Scholar
Marescaux J, Diana M. Next step in minimally invasive surgery: hybrid image-guided surgery. J Paediatr Surg. 2015;50(1):30–6.CrossRefGoogle Scholar
Sultan TA, van As AB. Review of tracheobronchial foreign body aspiration in the south African paediatric age group. J Thorac Dis. 2016;8(12):3787–96.CrossRefGoogle Scholar
Gill RR, Poh AC, Camp PC, Allen JM. MDCT evaluation of central airway and vascular complications of lung transplantation. Am J Roentgenol. 2008;191(4):1046–56.CrossRefGoogle Scholar
Shinagawa N, Yamazaki K, Onodera Y, et al. CT- guided transbronchial biopsy using an ultrathin bronchoscope with virtual bronchoscopic navigation. Chest. 2004;125:1138–43.CrossRefGoogle Scholar
Yanagiya M, Matsumoto J, Nagano M, Kusakabe M, Matsumoto Y, Furukawa R, Ohara S, Usui K. Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation.A case report. Medicine (Baltimore). 2018;97(7):e9921.CrossRefGoogle Scholar
Shitrit D, Valdsislav P, Grubstein A, Bendayan D, Cohen M, Kramer MR. Accuracy of virtual bronchoscopy for grading tracheobronchial stenosis∗ correlation with pulmonary function test and Fiberoptic bronchoscopy. Chest. 2005;128(5):3545.CrossRefGoogle Scholar
Cho EN, Haam SJ, Kim SY, Chang YS, Paik HC. Anastomotic airway complications after lung transplantation. Yonsei Med J. 2015;56(5):1372–8.CrossRefGoogle Scholar
Luecke K, Trujillo C, Ford J, Decker S, Pelaez A, Hazelton TR, Rojas CA. Anastomotic airway complications after lung transplant clinical, bronchoscopic and CT correlation. J Thorac Imaging. 2016;31:W62–71.CrossRefGoogle Scholar
Horton KM, Horton MR, Fishman EK. Advanced visualization of airways with 64-MDCT: 3-D mapping and virtual bronchoscopy. Am J Roentgenol. 2007;189(6):1387–96.CrossRefGoogle Scholar
Rezk-Salama C, Kolb A. Opacity peeling for direct volume rendering. Comp Graph Forum. 2006;25(3):597–606.CrossRefGoogle Scholar
Wacker FK, Vogt S, Khamene A, Jesberger JA, Nour SG, Elgort DR, Sauer F, Duerk JL, Lewin JS. An augmented reality system for MRI image guided needle biopsy: initial results in a swine model. Radiology. 2006;238(2):497–504.CrossRefGoogle Scholar