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Associate professor of radiology Yueh Z. Lee, MD, PhD, received a National Institute of Biomedical Imaging and Bioengineering R01 grant ($770.4K+), and will serve as principal investigator of a four-year, academic-industry partnering study titled “Stationary Digital Tomosynthesis for Transbronchial Biopsy Guidance.”


Associate professor of radiology Yueh Z. Lee, MD, PhD, received a National Institute of Biomedical Imaging and Bioengineering R01 grant ($770.4K+), and will serve as principal investigator of a four-year, academic-industry partnering study titled “Stationary Digital Tomosynthesis for Transbronchial Biopsy Guidance.”

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Associate Professor of Radiology Yueh Z. Lee

As expanding lung cancer screening programs drive rising numbers in lung lesion detection, this study addresses the need for next-stage development of a more optimal approach to lung nodule localization.

To date, modalities used for imaging-guided intraoperative bronchoscopy all have demonstrated drawbacks limiting their long-term use for early-stage lung cancer diagnosis and screening. Bronchoscopy and biopsy offer the lowest procedural complications, yet generate moderate diagnostic yields (70%). Other standard modalities used for lung nodule localization have a spectrum of major drawbacks, including: 1) Lack of real-time image confirmation of the lesion at time of biopsy – Radial endobronchial ultrasound (r-EBUS); 2) Poor target lesion visualization – Single-plane and bi-plane fluoroscopy projection x-rays; 3) High radiation dose and expense – Standard CT; and 4) Cumbersome X-ray source and detector crowding procedural space, disadvantaging patient care – (investigative) Cone-beam CT (CBCT). The most promising approach to real-time visualization in biopsy used for localization — combining electronic navigation bronchoscopy (EMN-B) with intraoperative imaging biopsy – has shown challenges such as limited virtual imaging guidance, lack of respiratory gating, compromised bronchoscope reach and loss of guidance during localization in pre-clinical studies.

To improve upon these limited approaches to peripheral nodule biopsy, Lee’s collaborative team of basic scientists and clinical research physicians, physicists (UNC) and software scientists (UNC & Kitware) will refine a novel intraoperative chest tomosynthesis (iDCT) system for early-stage, pre-clinical investigation.

Over the study period (9/15/2019-5/31/2023), the collaborative investigators will develop and evaluate 3D visualization software in a pre-clinical, simulated interventional pulmonology procedural workflow. The team will specifically optimize stationary chest tomosynthesis imaging protocols, evaluate rapid CT to tomosynthesis image registration techniques, and integrate the software control and guidance system in a system for pre-clinical large animal evaluation.

The UNC-Kitware collaborative team of physicists, computer scientists, radiologists and interventional pulmonologists aims to refine a stationary iDCT system based on the linear x-ray array invented at UNC based on carbon nanotube field emission. Its lack of source or detector motion overcomes the challenges of thoracic cavity physical motion observed in other imaging guided-approaches to bronchoscopy, including limited diagnostic sensitivity, tumor movement, poor resolution and other intraprocedural hindrances. The imaging and bronchoscope guidance can be performed without the need for any motion of the imaging hardware, unlike conventional c-arms or fluoroscopy suites.

If advanced to long-term clinical utility, this novel system would equip interventional pulmonologists and other interventionalists with unprecedented stereoscopic instrumentation for imaging-guided bronchoscopy in peripheral nodule biopsy. An intraoperative bronchoscopy tool with diagnostic yields superior to other modalities would in the long-term improve earlier-stage, more effective and safer lung cancer diagnosis and reduce morbidity in lung cancer and patient screening.