Standardized image-guided and robotic assisted biopsies in lung cancer

Annually, approximately 10,000 people die from lung cancer, making lung cancer by far the leading cause of cancer deaths. The prognosis is generally poor but increases greatly when lung cancer is detected at an early stage. This is why the introduction of lung cancer screening is investigated in another CMI-nen project: the NELSON study.

In the NELSON study participants with a high risk of lung cancer are included and participants in the screen arm are screened with multi-detector CT. Lesions detected in the lung (lung nodules) are characterized based on volume, growth rate (volume doubling time) and other radiological features. Participants with suspicious lung nodules are referred to a pulmonary physician for further diagnostic work up.

Besides additional imaging such as bronchoscopy and PET-CT the pulmonary physician requires tissue of the nodule to diagnose lung cancer and to accurate determine the treatment. For peripheral nodules this can be done using CT guided transthoracic biopsy. This is an iterative procedure where a biopsy needle is inserted between the ribs and guided towards the nodule, using CT scans to check the position of the needle after every repositioning. When the nodule is reached the biopsy can be performed.

Because of respiratory movement the position of the nodule is not stationary, making it a difficult procedure to perform. Also, the repetitive manipulation of the biopsy needle leads to a pneumothorax in 40% of the cases and if large vessels are hit, bleeding can occur. This increases hospital stay and thereby costs.

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Partner Interaction

Role DEMCON:

DEMCON will focus on the further development of the CT-compatible robot, including the management of the puncture technique. 

Role YTEC Imaging BV:

YTEC will provide expertise to develop standards for data storage, data transfer and anonimisation of patient data so that the data can be made suitable for larger patient studies. 

Role UMCG:

The following researchers will participate in the project in the University Medical Center Groningen Prof. Dr. M. Oudkerk (professor of radiology), Prof. Dr. H. Groen (professor of pulmonary diseases), Prof. Dr. R. Vliegenthart (investigator radiology). These researchers represent well-established research groups with proven value in the field of lung cancer. The UMCG will focus on the project at the real-time processing of the CT images and clinical utility, application and validation of the puncture technique. The UMCG will fund a doctoral student who will focus on image processing. The second candidate (financed by SIEMENS) will focus on 3D localization and robot controll.

Role UTwente:

Prof. Misra represents a renowned research group in the field of electrical engineering and is among the top when it comes to send flexible needles into the body. The University of Twente is a strategic partner of the CMI and prof. Misra will bring its expertise in the project on the localization and management of needles and the development of patient-specific computer models of the lungs.

Role Siemens:

In this project Siemens will focus on the further development of imaging technology (CT) and the necessary software for the real-time processing of the obtained information CT. SIEMENS will contribute CT equipment in the project (in kind) and further it will fund a researcher for the project. It also maintains its R&D laboratories in Germany and the United States open to the project partners. The intention is to meet annually with the development team to organize a field trip to the R&D laboratories to fits closely developments in the project at the cutting edge imaging technology.

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