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Minerva Pneumologica 2009 September;48(3);203-18


language: English

Virtual bronchoscopy

G. McLennan 1-3

1 Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; 2 Department of Radiology, University of Iowa, Iowa City, IA, USA; 3 Biomedical Engineering, University of Iowa, Iowa City, IA, USA


The digital revolution has enabled rapid calculations to be performed through the use of computer technology. Digital imaging is now ubiquitous in society, often commonly now bundled with cell phone applications. Similar digital imaging technology has rapidly transformed the practice of medicine. Multi-row detector computer tomography (MDCT) and charged coupled device (CCD) video endoscopy are now ubiquitous in the healthcare setting. These devices in imaging the human body generate enormous amounts of digital data that can now be processed by inexpensive computers into usable (qualitatively and quantitatively) image representations of the human body in health and disease. The human bronchial tree can be extracted from MDCT scan datasets and displayed as a solid three-dimensional (3D) structure or as an endobronchially viewed hollow tube structure. Both renderings are effectively referred to as virtual bronchoscopy and are now accurate representations of the bronchial tree if image acquisition is rapid without compounding breathing movement and if suitable software is used to define the airway wall boundaries. Both of these conditions are now satisfied as the digital revolution creates better hardware and software solutions. Image based datasets, those from MDCT and CCD bronchoscopy are able to be manipulated by image processing software to not just portray a qualitative representation of anatomy, but also to be quantitatively measured for such things as airway dimensions, airway wall thickness, and airway color. The relevant parts of these image datasets also can be used to develop predictive models of disease pathology outcomes through the new process of eidomics. These very very detailed datasets are very informative about the human lung structure and function and are increasingly likely to be viewed in true 3D viewing circumstances. It remains important that the images are viewed at the point of service and in pulmonary practice, that is the pulmonary clinic or the bronchoscopic laboratory, and that the end user does not rely on increasingly inadequate written reports. Evidence from many centers around the world would now strongly suggest that virtual bronchoscopy techniques, at least those resulting from MDCT scan images, be utilized routinely in pulmonary practice to enhance the understanding, investigation, and therapy of lung disorders.

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