Ultra-low-dose intraoperative X-ray imager for minimally invasive surgery: a pilot imaging study

Haewook Park, Kook Nam Han, Byeong Hyeon Choi, Hyunsuk Yoon, Hyun Joon An, Jae Sung Lee, Hyun Koo Kim

    Research output: Contribution to journalArticlepeer-review

    4 Citations (Scopus)

    Abstract

    Background: With advances in surgical technology, thoracic surgeons have widely adopted minimally invasive limited-resection techniques to preserve normal tissues. However, it remains difficult to achieve in situ localization of invisible pulmonary nodules during surgery. Therefore, we proposed an in situ ultra-low-dose X-ray imaging device for intraoperative pulmonary nodule localization during minimally invasive surgeries. Methods: The proposed device features a hand-held type and consists of a carbon nanotube-based X-ray source and an intraoral dental sensor. In a preclinical study, we created pseudo pulmonary nodules using ex vivo pig lungs. Subsequently, its clinical feasibility was evaluated using ex vivo lung cancer specimens from patients with cancer who had undergone minimally invasive surgery. Results: Using the proposed device, we successfully differentiated normal and abnormal tissues from X-ray images of resected lung specimens. In addition, our proposed device only yielded an average radiation dose of 90.9 nGy for a single acquisition of X-ray images and demonstrated excellent temperature stability under consecutive X-ray irradiations. The radiation exposure of our proposed device (0.1±0.0006 μSv/h) was significantly lower than that of conventional C-arm fluoroscopy (41.5±51.8 μSv/h). In both preclinical and clinical studies, the margin of nodule shadows was clearly visualized using the proposed device. Conclusions: The proposed device substantially reduced radiation exposure to staff and patients and may allow in situ localization of pulmonary nodules. Our proposed device clearly revealed the margins of lung nodules with radiocontrast injection and showed the potential to identify solid nodules without the use of radiocontrast agents.

    Original languageEnglish
    Pages (from-to)588-599
    Number of pages12
    JournalTranslational Lung Cancer Research
    Volume11
    Issue number4
    DOIs
    Publication statusPublished - 2022 Apr

    Bibliographical note

    Funding Information:
    We thank LIVSMED, VSI, and HDX for supporting the mechanical design and providing the X-ray sources and sensors. We also thank the veterinary team at the Korea University Medical Center (KUMC) for supporting animal experiments. Funding: This work was supported by grants from the Korea Evaluation Institute of Industrial Technology funded by the Korean Ministry of Trade, Industry and Energy (Grant No. 2015-4-10052467) and the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, Ministry of Food and Drug Safety) (Project No. 1711138151, KMDF_PR_20200901_0094_02).

    Publisher Copyright:
    © 2022 AME Publishing Company. All rights reserved.

    Keywords

    • Ultra-low-dose
    • X-ray imaging
    • lung cancer
    • minimally invasive surgery

    ASJC Scopus subject areas

    • Oncology

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