Virtual Bronchoscopy

Virtual bronchoscopy is evolving rapidly, and is becoming accepted into standard clinical practice. Virtual bronchoscopy is a term, which encompasses not only multi-row detector X-ray computerized tomography-derived images, but also other computer graphics and computer vision-derived value-added digital imagery. Other imaging data sources used to create three-dimensional image renderings of the bronchial tree include magnetic resonance imaging, positron emission tomography, the digital colour image taken at real bronchoscopy as part of macro-optical imaging, and various emerging micro-optical imaging modalities, such as catheter-based confocal microscopy and optical coherence tomography. Software solutions now exist for providing simple renderings of the bronchial tree through which a fly-through of the airway lumen along the centreline of the airway can be added (the fly-through mimics the view that a real flexible bronchoscope affords the operator). The images so produced are visually accurate and with currently available software also analytically correct. More advanced virtual bronchoscopic applications, including image-based pathfinding to mediastinal and peripheral lung structures, are also in development, and are finding their way into clinical studies. Exciting and synergistic data sets composed of image data from multiple image sources are also being constructed. One emerging issue is to enhance the understanding and reporting on these data sets, which are often complex, and which are full of useful as well as redundant information. The new discipline of eidomics will inform the non-specialist end user, and act to predict important outcomes. These increasingly powerful tools will continue to advance the use of imaging in technology-supported personalized medicine, to compliment the information from genomics.