Steven C. Dimmer

Bronchoscopic Implantation of a Novel Wireless Electromagnetic Transponder in the Canine Lung: A Feasibility Study

PURPOSE The success of targeted radiation therapy for lung cancer treatment is limited by tumor motion during breathing. A real-time, objective, nonionizing, electromagnetic localization system using implanted electromagnetic transponders has been developed (Beacon electromagnetic transponder, Calypso Medical Technologies, Inc., Seattle, WA). We evaluated the feasibility and fixation of electromagnetic transponders bronchoscopically implanted in small airways of canine lungs and compared to results using gold markers. METHODS AND MATERIALS After approval of the Animal Studies Committee, five mongrel dogs were anesthetized, intubated, and ventilated. Three transponders were inserted into the tip of a plastic catheter, passed through the working channel of a flexible bronchoscope, and implanted into small airways of a single lobe using fluoroscopic guidance. This procedure was repeated for three spherical gold markers in the opposite lung. One, 7, 14, 28, and 60 days postimplantation imaging was used to assess implant fixation. RESULTS Successful bronchoscopic implantation was possible for 15 of 15 transponders and 12 of 15 gold markers; 3 markers were deposited in the pleural space. Fixation at 1 day was 15 of 15 for transponders and 12 of 12 for gold markers. Fixation at 60 days was 6 of 15 for transponders and 7 of 12 for gold markers, p value = 0.45. CONCLUSIONS Bronchoscopic implantation of both transponders and gold markers into the canine lung is feasible, but fixation rates are low. If fixation rates can be improved, implantable electromagnetic transponders may allow improved radiation therapy for lung cancer by providing real-time continuous target tracking. Developmental work is under way to improve the fixation rates and to reduce sensitivity to implantation technique.

A comparison of lung motion measured using implanted electromagnetic transponders and motion algorithmically predicted using external surrogates as an alternative to respiratory correlated CT imaging

Three-dimensional volumetric imaging correlated with respiration (4DCT) typically utilizes external breathing surrogates and phase-based models to determine lung tissue motion. However, 4DCT requires time consuming post-processing and the relationship between external breathing surrogates and lung tissue motion is not clearly defined. This study compares algorithms using external respiratory motion surrogates as predictors of internal lung motion tracked in real-time by electromagnetic transponders (Calypso® Medical Technologies) implanted in a canine model. Simultaneous spirometry, bellows, and transponder positions measurements were acquired during free breathing and variable ventilation respiratory patterns. Functions of phase, amplitude, tidal volume, and airflow were examined by least-squares regression analysis to determine which algorithm provided the best estimate of internal motion. The cosine phase model performed the worst of all models analyzed (R2 = 31.6%, free breathing, and R2 = 14.9%, variable ventilation). All algorithms performed better during free breathing than during variable ventilation measurements. The 5D model of tidal volume and airflow predicted transponder location better than amplitude or either of the two phasebased models analyzed, with correlation coefficients of 66.1% and 64.4% for free breathing and variable ventilation respectively. Real-time implanted transponder based measurements provide a direct method for determining lung tissue location. Current phase-based or amplitude-based respiratory motion algorithms cannot as accurately predict lung tissue motion in an irregularly breathing subject as a model including tidal volume and airflow. Further work is necessary to quantify the long term stability of prediction capabilities using amplitude and phase based algorithms for multiple lung tumor positions over time.