Page 65 - ECBIP 2021_Program

MODERATED e-POSTER SESSION 05:
Imaging,Guiding,Training and Navigation modalities
PP35
Aim: While pulmonary function tests have been the standard for meaning “airflow”, it poorly characterizes regional heterogeneity in airflow. Ventilation scans with radioactive probes such as xenon or tagged technetium demonstrates airflow distribution, it does not do so dynamically. Hyperpolarized helium allows for dynamic airflow imaging but is cumbersome and very expensive. We wish to provide a simple, almost universally accessible approach to the analysis of dynamic air-flow changes on a regional basis using readily available fluoroscopic imaging. This is a pre-human, clinical animal study of how the 4D – XV (X-ray Velocimetry) system can demonstrate in real-time dynamic changes in regional airway in response to lung insult and injury. Methods: 6 each of porcine (22-26kg) and ovine (40-52kg) subjects imaged with a C-arm fluoroscope while receiving bronchoscopically targeted delivery of regional lung injury induced by LPS or HCL, with timed sequential imaging of the entire thorax. Proprietary software analysis of the regional distribution of ventilation during spontaneous respiration based on previous work in mice models of lung injury. Results are displayed in a color coded format to indicate changes in regional airflow.
Results: Regional specific ventilation at peak inspiration for an AP slice (figure 2) at three time points bfore, 5 mins and 20 mins following instillation. Ventilation values are normalized by the mean specific ventilation. Red depicts regions of low ventilation, green depicts regions of average ventilation and blue depicts regions of high ventilation. Axial Slices for slices with 8mm spacing are also generated (not shown). Measurements are only provided for the regions that have been captured in the fluoroscopy images. From these images ventilation heterogeneity can be used to quantify the regional variability of the ventilation.The measure is the ratio of the interquartile range to the mean of the specific ventilation.
Conclusion: This animal bronchoscopic platform used to deliver regional lung insult to simulate acute lung injury effectively captures in an accelerated fashion dynamic changes in regional airflow. We anticipate further use of this system with modifications to simulate situations of regional airway obstruction (lung, lobes, lobar segments) and re- opening after therapeutic interventions, or sequential occlusion to simulate bronchoscopic lung volume reduction and effects on regional airflow redistribution.
Figure 1: A) C-arm fluoroscopic image sequences obtained during spontaneous respiration; B) coronal C) sagital view of the site specific intervention
Figure 2: Single midline coronal slice at peak inspiration A) pre-, B) 5-mins post, and C) 20-post instillation of LPS or HCL. Changes to the distribution of ventilation are demonstrated through the change in the heat
map (red areas of low mean specific ventilation; green areas unchanged; blue areas increased mean specific ventilation)
REAL-TIME LUNG FUNCTION IMAGING AND VENTILATION ANALYSIS WITH
THE 4 DIMENSIONAL XV (X-RAY VELOCIMETRY): A PORCINE AND OVINE BRONCHOSCOPIC RESEARCH PLATFORM
Jason Kirkness1, Jonathan Dusting1, Andreas Fouras1, Martin Donnelley2, Rex Yung3, David Parsons2
1 4Dmedical, Woodland Hills, USA
2 University of Adelaide, Adelaide, Australia 3 St. Alexius Health, Bismark, USA
ECBIP 2021 65
6th European Congress
for Bronchology and Interventional Pulmonology
OCTOBER ECBIP 15 - 17
ATHENS - GREECE 2021
Book of Abstracts