Search PubMed⌕ Search

PubMed · 15191102

Threshold selection in virtual bronchoscopy: phantom study and clinical implications.

Abstract

PURPOSE: To investigate the effect of the threshold selection on the apparent diameter of a virtual bronchus and the virtual wall morphology and to examine the parameters that can affect the selection of the appropriate threshold for virtual bronchoscopy with single slice computed tomography. MATERIAL AND METHODS: A bronchial phantom containing plastic tubes simulating the airways of the tracheobronchial tree was constructed. The diameters of the virtual images of these tubes were measured using various thresholds for two different materials surrounding the tubes: air and water. These measurements were correlated with the density in HU of the walls. Furthermore, data from 20 virtual bronchoscopies in patients were retrospectively analyzed in the same way. RESULTS: The diameter of a virtual bronchus is strongly affected by the selected threshold. The appropriate threshold for accurate diameter representation depends on the density of the bronchial wall. CONCLUSION: Our results suggest that in clinical practice a single threshold value cannot be used for imaging all segments of the tracheobronchial tree. While a value of -520 is appropriate for the trachea and lobar segments, values down to -720 could be needed on the level of segmental and subsegmental bronchi. At these levels, a threshold value about 65 HU more negative than the value where the artificial holes appear on the virtual bronchial walls could be used.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

P N Maniatis, C C Triantopoulou, I A Tsalafoutas, K S Malagari, I G Siafas, E A Psatha, E D Koulentianos, D A Kelekis. 2004. Threshold selection in virtual bronchoscopy: phantom study and clinical implications.. https://doi.org/10.1080/02841850410003761

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Bronchoscopy assisted neonatal tracheostomy (BANT): a new technique.

Neonatal tracheostomy is a complex procedure associated with significant morbidity due to the small size and medical condition of the patient. Standard techniques have been well described and depend on palpation and visual identification of the trachea in the wound. This can at times be exceedingly difficult depending on the anatomical configuration of the neck. The potential for damage to adjacent neurovascular structures increases as dissection strays away from the midline. We describe a new technique that restricts dissection strictly to the midline and ensures accurate placement of the tracheostomy below the first tracheal ring. We feel that this technique will significantly shorten the operative time for the procedure and also reduce the morbidity associated with it.

Bronchoscopes↗

Nosocomial outbreak of Pseudomonas aeruginosa infections related to a flexible bronchoscope.

An outbreak of Pseudomonas aeruginosa infections affecting 17 patients was detected in the 27-bed intensive care unit (ICU) of a community hospital from 1 July to 30 September 2003. An ambidirectional cohort study was conducted to identify the risk factors for infection. Nosocomial infections were defined using the criteria of the Centers for Disease Control and Prevention. Random arbitrary polymorphic DNA-polymerase chain reaction was used for genotypic characterization. Logistic regression analyses demonstrated that case patients were more likely than non-cases to have had a longer stay in the ICU, and to have undergone mechanical ventilation and antimicrobial treatment. The multi-variate analysis identified recent bronchoscopy [risk ratio (RR) 3.8, 95% confidence interval (CI) 2.5-3.9] and exposure to an infected patient (RR 2.9, 95% CI 1.1-3.7) as independent risk factors. Molecular analysis showed that of the nine isolates available, four patients had a similar strain. The factor with the strongest influence on the risk of death was infection with P. aeruginosa (RR 2.1, 95% CI 1.0-2.4, P=0.04). A combined infection control strategy was implemented, including strict compliance with isolation precautions and recommendations for cleaning and disinfecting bronchoscopes, and a sharp reduction in the incidence of P. aeruginosa infection followed. It is thought that this outbreak was caused by patient-to-patient transmission and infection from a common source, i.e. the flexible bronchoscope.

Bronchoscopes↗