REBOT: Robotic Endobronchial Optical Tomography

Lung cancer is a challenging disease to diagnose and treat, and is the most common cause of cancer death in both men and women worldwide. Five year survival rates remain poor at 9.0%, and on a global basis, the 2012 statistics suggest that lung cancer was responsible for 1.59 million deaths. A particular difficulty is that most lung cancers are diagnosed at a late stage, with about 75% of patients having advanced disease at the time of diagnosis. Identification of patients with lung cancer at an earlier stage is therefore vital if outcomes are to be improved.

CT screening can identify possible cancerous nodules in the lung, but biopsy and histology, in which a tissue sample is examined under a microscope, is then required for diagnosis. The standard procedure to extract the tissue sample is trans-thoracic biopsy, in which a needle is inserted through the chest wall, typically under CT image guidance. This provides good diagnostic results, but is associated with complications, especially pneumothoraces (collapsed lung) which occurs in 15% of cases. More recently, technical advances have allowed biopsy to be performed through a bronchoscope, reducing the risk of complications and allowing the procedure to be performed during routine examination sessions. However, success is highly operator dependent and for remote, small nodules, the diagnostic rate (the yield) is poor. This is due to a number of factors, including the complexity of the bronchial tree, patient motion due to breathing (particularly at distal segments), poor ergonomics, and the large diameter of bronchoscopes prohibiting access beyond fourth generation bronchial segments (the fourth level of 'splitting' in the bronchial tree).

The purpose of the REBOT project is to develop a robot-guided endobronchial probe that will allow access to the deepest reaches of the lung. It will be introduced through a working channel of a bronchoscope, making it highly compatible with current procedures. The probe will have integrated optical coherence tomography (OCT) and fluorescence imaging to allow multi-modal visualisation of the morphological and cellular details of the airways. Optical coherence tomography will provide 3D images to a depth of 1-2 mm into the tissue, while fluorescence imaging will provide high resolution surface imaging. These real-time imaging techniques will be used to help navigate the probe to the correct location for extraction of the biopsy tissue sample, increasing the chances of a successful diagnosis.

The research is in line with Frontiers of Physical Intervention, one of the four EPSRC health technology grand challenges, and addresses major research issues in medical imaging and robotics and autonomous systems. Lung cancer is the most common cause of cancer death in both men and women worldwide. With the development of the national lung screening initiative, there is increasing need to navigate to specific locations, particularly remote segments of the lung. The current approach of CT-guided percutaneous lung biopsies is associated with a high risk of complications, and the development of robotically assisted endobronchial navigation combined with in situ, in vivo imaging offers significant advantages. The proposal supports some of the key strategies identified by the UK government (Improving Outcomes: A Strategy for Cancer) in terms of national lung cancer screening, early diagnosis, better treatment and an improved patient experience.

The stakeholders who will benefit from this research include: Academia (both UK and international) in medical imaging, robotics, biophotonics, surgical oncology and general biomedical engineering; Public and private sectors in healthcare provision; Medical devices industry; Charities championing improved healthcare provision and disease focussed organisations particularly on cancer therapy; and more importantly patients and the general public.

The project will stimulate creative and adventurous research that underpins the key objectives of the project. Throughout the project, we will actively encourage early career researchers to lead and take ownership of new concept generation with direct clinical/industrial interaction. Secondment to industrial collaborators and across consortium partners will be arranged and the team will be encouraged to lead public dissemination activities and develop the necessary managerial, vocational and entrepreneurial skills for career progression. People and skills development is a major agenda of this project.

Through technological innovation and effective collaboration with all project stakeholders, we will ensure effective knowledge transfer, and clinical translation with measurable clinical impact. The potential IPs to be generated range from licensing, platform development, and commercial spin-offs, to mixed independent exploitation of the basic technology developed. We already have strong support from the industrial partners of the project and will work with them to identify potential opportunities for commercial exploitation throughout the duration of the project. Key project team members have already extensive experience in commercial exploitation of academic research. Such expertise is essential to the success of our exploitation strategies to ensure the long-term sustainability of the research centres. The project addresses a niche yet fast growing area of robotics and it can potentially strengthen UK's technological and economic competitiveness.

The impact of the proposed project to develop a miniaturised continuum robot for endobronchial intervention will be demonstrated through certified devices with extensive in vivo validation. Uptake by the NHS will provide clinicians with data that provides the basis for changing clinical practice to improve patient outcomes and quality of life. Through clinical evidence, the project team will also actively promote public awareness of our research and develop a shared vision for future healthcare.