Virtual and augmented 3D bronchoscopy navigation based on C-arm fluoroscopy

Instrument guidance during bronchoscopy is a very intricate task, which demands profound anatomical knowledge and good orientation skills from the physician. Apart from bronchoscopic video, intraoperative C-arm images of the instruments inside the airways are the only auxiliary means available. By tracing the 2D position of the instrument on the fluoroscopy back to its 3D position inside the bronchial tree, an effective navigation support is provided. Given the intraoperative C-arm pose, a preoperative segmentation of the airways and automatic tracking of the 2D position of the instrument on the fluoroscopy, this 3D position of the bronchoscopic instruments can be followed during the whole intervention without manual user interaction. In this paper, we present a bronchoscopy navigation system for virtual preoperative planning and augmented intraoperative guidance. The whole system was successfully tested by inserting a bronchoscope into a bronchial tree model under continuous fluoroscopy. During the procedure, the current 3D position of the bronchoscope's tip could be tracked and visualized inside the bronchial tree segmentation.