Dataset Information

Ultra-low-dose intraoperative X-ray imager for minimally invasive surgery: a pilot imaging study.

ABSTRACT:

Background

With advances in surgical technology, thoracic surgeons have widely adopted minimally invasive limited-resection techniques to preserve normal tissues. However, it remains difficult to achieve in situ localization of invisible pulmonary nodules during surgery. Therefore, we proposed an in situ ultra-low-dose X-ray imaging device for intraoperative pulmonary nodule localization during minimally invasive surgeries.

Methods

The proposed device features a hand-held type and consists of a carbon nanotube-based X-ray source and an intraoral dental sensor. In a preclinical study, we created pseudo pulmonary nodules using ex vivo pig lungs. Subsequently, its clinical feasibility was evaluated using ex vivo lung cancer specimens from patients with cancer who had undergone minimally invasive surgery.

Results

Using the proposed device, we successfully differentiated normal and abnormal tissues from X-ray images of resected lung specimens. In addition, our proposed device only yielded an average radiation dose of 90.9 nGy for a single acquisition of X-ray images and demonstrated excellent temperature stability under consecutive X-ray irradiations. The radiation exposure of our proposed device (0.1±0.0006 µSv/h) was significantly lower than that of conventional C-arm fluoroscopy (41.5±51.8 µSv/h). In both preclinical and clinical studies, the margin of nodule shadows was clearly visualized using the proposed device.

Conclusions

The proposed device substantially reduced radiation exposure to staff and patients and may allow in situ localization of pulmonary nodules. Our proposed device clearly revealed the margins of lung nodules with radiocontrast injection and showed the potential to identify solid nodules without the use of radiocontrast agents.

SUBMITTER: Park H

PROVIDER: S-EPMC9073745 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Ultra-low-dose intraoperative X-ray imager for minimally invasive surgery: a pilot imaging study.

Park Haewook H Han Kook Nam KN Choi Byeong Hyeon BH Yoon Hyunsuk H An Hyun Joon HJ Lee Jae Sung JS Kim Hyun Koo HK

Translational lung cancer research 20220401 4

<h4>Background</h4>With advances in surgical technology, thoracic surgeons have widely adopted minimally invasive limited-resection techniques to preserve normal tissues. However, it remains difficult to achieve <i>in situ</i> localization of invisible pulmonary nodules during surgery. Therefore, we proposed an <i>in situ</i> ultra-low-dose X-ray imaging device for intraoperative pulmonary nodule localization during minimally invasive surgeries.<h4>Methods</h4>The proposed device features a hand ...[more]

PMID: 35529795

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Project description:Background and objectiveThe increasingly widespread application of computed tomography (CT) in the screening and follow-up of patients with lung disease has concomitantly increased the detection rate of pulmonary nodules. Currently, minimally invasive thoracic surgery (MITS) has become the preferred method of surgery for patients with pulmonary ground-glass nodules (GGNs) due to its advantages minimal invasiveness and rapid recovery. However, target nodule identification during MITS is sometimes challenging due to the inherent characteristics of these nodules, especially when they are small and distant from the pleura. This review details the many methods used for the intraoperative localization of pulmonary nodules.MethodsLiterature published in the Cochrane Library, PubMed, ClinicalTrials, and China National Knowledge Infrastructure from 1990 to 2022 were searched and analyzed to obtain a comprehensive review of the different methods of identifying pulmonary nodules. Literature related to animal testing were excluded.Key content and findingsAn overview of the recent progress in the clinical methods for intraoperative localization of pulmonary nodules [including CT-guided percutaneous placement of markers; bronchoscopy-guided placement of markers; intraoperative ultrasonography; three-dimensional (3D) printing technology; artificial intelligence (AI); and intraoperative molecular imaging (IMI)] was conducted. The advantages and disadvantages, as well as the complications associated with existing research methods, were summarized to assist doctors in the development of optimized clinical strategies.ConclusionsClinicians can communicate with the multidisciplinary team and select the appropriate positioning method according to each patient's individual situation and the available support of the equipment and technology of the institution. Certain non-invasive and specific identification methods may have clinical potential in pulmonary nodule localization in the future.

Project description:PurposeIntraoperative detection and removal of microscopic residual disease (MRD) remain critical to the outcome of cancer surgeries. Today's minimally invasive surgical procedures require miniaturization and surgical integration of highly sensitive imagers to seamlessly integrate into the modern clinical workflow. However, current intraoperative imagers remain cumbersome and still heavily dependent on large lenses and rigid filters, precluding further miniaturization and integration into surgical tools.ProceduresWe have successfully engineered a chip-scale intraoperative micro-imager array-without optical filters or lenses-integrated with lanthanide-based alloyed upconverting nanoparticles (aUCNPs) to achieve tissue imaging using a single micro-chip. This imaging platform is able to leverage the unique optical properties of aUCNPs (long luminescent lifetime, high-efficiency upconversion, no photobleaching) by utilizing a time-resolved imaging method to acquire images using a 36-by-80-pixel, 2.3 mm [Formula: see text] 4.8 mm silicon-based electronic imager micro-chip, that is, less than 100-µm thin. Each pixel incorporates a novel architecture enabling automated background measurement and cancellation. We have validated the performance, spatial resolution, and the background cancellation scheme of the imaging platform, using resolution test targets and mouse prostate tumor sample intratumorally injected with aUCNPs. To demonstrate the ability to image MRD, or tumor margins, we evaluated the imaging platform in visualizing a single-cell thin section of the injected prostate tumor sample.ResultsTested on USAF resolution targets, the imager is able to achieve a resolution of 71 µm. We have also demonstrated successful background cancellation, achieving a signal-to-background ratio of 8 when performing ex vivo imaging on aUCNP-injected prostate tumor sample, improved from originally 0.4. The performance of the imaging platform on single-cell layer sections was also evaluated and the sensor achieved a signal-to-background ratio of 4.3 in resolving cell clusters with sizes as low as 200 cells.ConclusionThe imaging system proposed here is a scalable chip-scale ultra-thin alternative for bulky conventional intraoperative imagers. Its novel pixel architecture and background correction scheme enable visualization of microscopic-scale residual disease while remaining completely free of lenses and filters, achieving an ultra-miniaturized form factor-critical for intraoperative settings.

Project description:BackgroundThoracic surgery is an invasive procedure and there has been a move towards minimally invasive approaches. This includes video-assisted thoracoscopic surgery. Non-intubated video-assisted thoracoscopic surgery without endotracheal intubation has been developed with a view to avoiding complications associated with intubation including tracheal injury, vocal cord injury and lung impairment due to mechanical ventilation. This study aims to compare outcomes from non-intubated 'completely tubeless' versus intubated 'partially tubeless' minimally invasive thoracic surgery.MethodsA single-institution, prospective randomized clinical trial was conducted comparing patients who underwent minimally invasive lung completely tubeless versus partially tubeless surgery, both with enhanced recovery. The primary outcome was the short-term postoperative complication rate. Binary logistic regression analysis was performed to determine the significant predictors of severe mediastinal shift and receiver operating characteristic (ROC) curve plots were drawn.ResultsAmong the 348 patients, 174 patients were assigned to the completely tubeless group and 174 patients were assigned to the partially tubeless group. There was no difference in postoperative complications including pulmonary complications, supraventricular arrhythmia, acute myocardial infarction, acute cerebral stroke, venous thromboembolism and urinary retention. The completely tubeless protocol was associated with a higher proportion of early mobilization (66.7% versus 55.7%, P = 0.047), a shorter median duration of drainage (1.0 versus 2.0 days, P = 0.002), and a shorter median duration of postoperative hospital stay (2.0 versus 3.0 days, P = 0.001). The completely tubeless group had less of a difference in white blood cell count before and after the operation (P = 0.042). Binary logistic regression analysis revealed that weight was a significant predictor of mediastinal shift in the completely tubeless group.ConclusionUnder enhanced recovery after surgery protocols, there is no difference in postoperative complications in patients undergoing completely or partially tubeless surgery. However, patients having completely tubeless surgery have shorter durations of postoperative drainage, shorter durations of hospital stay, milder systemic inflammatory reactions, and better immune protection than patients who undergo lung resection with a partially tubeless protocol. The severity of mediastinal shift may be mainly related to body-weight.Registration numberNCT05269784 (http://www.clinicaltrials.gov).

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Dataset Information

Ultra-low-dose intraoperative X-ray imager for minimally invasive surgery: a pilot imaging study.

Background

Methods

Results

Conclusions

Publications

Ultra-low-dose intraoperative X-ray imager for minimally invasive surgery: a pilot imaging study.

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