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Virtual Reality Promises to Improve Bronchoscopy

Virtual Reality Promises to Improve Bronchoscopy

CHICAGO--By creating a virtual reality environment, physicians
in the not-too-distant future will be able to move through, around,
and into a patient's airways to search for tumors, enlarged lymph
nodes, and abnormal masses in the walls of the bronchi and surrounding
tissue on a computer screen, David J. Vining, MD, predicted at
the annual scientific meeting of the Radiological Society of North
America.

"What we're doing right now is relatively crude, but what
we'll be doing in 5 years will be very sophisticated," said
Dr. Vining, assistant professor of radiology, Bowman Gray School
of Medicine, Winston-Salem, NC. [A report on Dr. Vining's research
on virtual colonoscopy appeared in the July, 1994, issue of Oncology
News International (ONI), page 29.]

By the turn of the century, virtual reality technology probably
will be advanced enough to be used routinely to obtain three-dimensional
(3D) views of the airways that reveal anatomic structures which
normally remain hidden during bronchoscopy, such as the lymph
nodes and blood vessels. It will provide a clear road map physicians
can follow to guide the placement of biopsy needles in suspicious
lymph nodes during standard bronchoscopy, he said.

The technology also will be able to identify patients who should
not be subjected to bronchoscopy. "Sometimes, bronchoscopy
is unsuccessful because there are blockages in the bronchi that
restrict access with an endoscope. Other times, there is a tumor
that is situated so it can't be seen with an endoscope. Virtual
bronchoscopy will be very good at predicting these things in advance,
thus sparing the patient the discomfort and expense of an unsuccessful
exam," Dr. Vining said.

25 Simulations to Date

To date, virtual reality simulations of the interior of the airways
have been created on more than 25 patients, to provide physicians
with a way of evaluating thin-section spiral computed tomographic
(CT) images from the perspective of the bronchoscopist. Special
software converts the CT images into 3D graphic elements that
can be displayed on a computer console and manipulated by means
of a computer mouse. "With this technology, physicians can
view exquisitely detailed reproductions of their patient's anatomy
as 3D, movable models on a video screen. The physicians can then
search for a tumor or other abnormality by 'navigating' through
the body, using a computer mouse to guide the direction of travel,"
Dr. Vining explained.

In a number of ways, virtual reality examination of the airways
has proved to be more medically illuminating than conventional
bronchoscopy, he added. The technology accurately predicted bronchial
involvement by mediastinal tumors, identified areas of bronchial
stenosis and bronchiectasis, and discovered several unsuspected
conditions, such as multiple aberrant bronchi.

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