WO2009059368A1 - A method of providing quantitative information about the lower airways of a lung - Google Patents

A method of providing quantitative information about the lower airways of a lung Download PDF

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Publication number
WO2009059368A1
WO2009059368A1 PCT/AU2008/001648 AU2008001648W WO2009059368A1 WO 2009059368 A1 WO2009059368 A1 WO 2009059368A1 AU 2008001648 W AU2008001648 W AU 2008001648W WO 2009059368 A1 WO2009059368 A1 WO 2009059368A1
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WO
WIPO (PCT)
Prior art keywords
lower airways
property
light
quantitative information
airways
Prior art date
Application number
PCT/AU2008/001648
Other languages
French (fr)
Inventor
David Sampson
Julian Armstrong
Matthew Leigh
Peter Eastwood
David Hillman
Jonathan Williamson
Jennifer Walsh
Martin Phillips
Original Assignee
The University Of Western Australia
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from AU2007906116A external-priority patent/AU2007906116A0/en
Application filed by The University Of Western Australia filed Critical The University Of Western Australia
Publication of WO2009059368A1 publication Critical patent/WO2009059368A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/6852—Catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0062—Arrangements for scanning
    • A61B5/0066—Optical coherence imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/41—Detecting, measuring or recording for evaluating the immune or lymphatic systems
    • A61B5/413—Monitoring transplanted tissue or organ, e.g. for possible rejection reactions after a transplant

Definitions

  • the present invention broadly relates to a method of providing information about a quantitative property of the lower airways of a lung.
  • the lower airways of a lung are defined as the tracheobronchial tree below the level of the vocal cords. Lung diseases often affect the topography of portions of the internal walls of lower airways. Changes in dimension and even airway obstruction are a usual consequence.
  • Bronchoscopes are used to provide qualitative information of internal airway anatomy.
  • a bronchoscope typically comprises a tube that is inserted through the nose or mouth into the airways of a patient .
  • the bronchoscope has a tip that is arranged for imaging the airway from within the lumen and contains a working channel to allow passage of other instruments or a wire into the lower airways.
  • a wire may be used to mark a position that is selected for insertion of a stent required for local widening of a narrowed airway segment .
  • the airway Prior to stent deployment, the airway may be widened by inflating a balloon.
  • the choice of a suitable balloon pressure and stent size is critical for successful widening of the airway and for maintenance of the patency of the airway.
  • objective assessment of the diameter of an airway segment is very difficult to achieve as bronchoscopic images are not quantitative. Consequently, stents, which are relatively expensive, are frequently displaced (if the stent is too small) or cause local damage (if the stent is too large) because of a discrepancy between actual and perceived airway diameter.
  • the present invention provides in a first aspect a method of providing quantitative information about a property of the lower airways of a lung using optical coherence tomography, the method comprising: inserting a probe head of an anatomical optical coherence tomography device into the lower airways; directing light to, and receiving reflected light from, an internal wall portion of the lower airways, the light being suitable for optical coherence tomography,- generating an electronic signal indicative of a phase difference between reference light and the received light; and determining a quantity associated with the property of the lower airways by processing the generated electronic signal using a computer and computer software when the probe is positioned in the lower airways.
  • Embodiments of the above-defined method have the significant advantage that information about the quantity associated with the property, such as a diameter, of a portion of the lower airways can be provided during a procedure and while the probe is positioned in the lower airways.
  • the method typically is conducted so that the quantity associated with the property is determined immediately after directing the light to, and receiving reflected light from, the internal wall portion of the lower airways.
  • the quantity associated with the property may be determined within less than 1, 2 or 3 minutes and may even be provided substantially in real time.
  • the method is conducted so that, at the time when the quantitative information is provided, further light is directed to, and reflected light received from, the internal wall portion of the lower airways to provide subsequently further quantitative information.
  • the step of directing light to, and receiving reflected light from, the internal wall portion of the lower airways typically comprises rotating the probe head, or the entire probe, about an axis.
  • the method typically comprises determining the topography of the section, typically for the entire section.
  • the step of determining the quantity associated with the property may comprise comprises selecting the property from one of a plurality of selectable properties .
  • the selected property may be the shortest diameter across a section of a portion of the lower airways .
  • the method may comprise moving the probe head along a tubular portion of the lower airways during rotation of the probe head. Further, the method may comprise determining an entire internal topography of the tubular portion of the lower airways .
  • the method may comprise selecting any opposing regions of the determined internal topography of the tubular portion and determining a distance between the selected opposing regions.
  • the method may comprise determining a length of the tubular portion, for example, the length of a focal airway stenosis.
  • the method may comprise the additional step of determining a cross- sectional area of the portion of the lower airways. Multiple cross-sectional images may also be combined to provide a measurement of the volume of a specific segment of the airways .
  • Providing the quantitative information typically comprises displaying the information on a monitor, for example in the form of an image .
  • the method comprises inserting the probe head into the lower airways of the lung with the aid of a bronchoscope .
  • Embodiments of the above-defined method provide the significant advantage that information concerning an internal diameter, and a change thereof, can be determined within a short period of time.
  • a stent may have to be inserted into an obstructed portion of the lower airways of a patient to widen that portion of the lower airways.
  • selection of a suitable balloon pressure and stent size for immediate insertion of the stent is facilitated.
  • the method may be conducted so that initially data is obtained using the probe head and the quantitative information concerning the portion of the lower airways is provided within a few minutes or less .
  • the stent may then be inserted immediately thereafter.
  • the method comprises determining the topography before (or above) and behind (or below) an obstruction of the portion of the lower airways .
  • the obtained information about the determined topography may then be processed to predict a suitable stent size (diameter and length) and/or balloon pressure for incorporation of the stent into the portion of the lower airways.
  • the above-defined method may be used for characterising the topography of a region where a transplanted airway is attached to a native airway portion of a patient. Narrowing of the lower airways at such a region is often a problem and embodiments of the above- defined method allow quantitative characterisation of such a narrowing .
  • the probe head typically is narrower than a bronchoscope and the step of inserting the probe head into the lower airways may comprise inserting the probe head through the bronchoscope (or any other tube facilitating passage into the lower airway such as an endotracheal tube) and further into the lower airways than the bronchoscope.
  • the bronchoscope or any other tube facilitating passage into the lower airway such as an endotracheal tube
  • the method according the embodiments of the present invention has the significant practical advantage of being able to pass beyond the obstruction where the bronchoscope cannot pass .
  • directing suitable light to, and receiving reflected light from, an internal wall portion of the lower airways may be conducted during movement of wall portions of the lower airways .
  • the provided quantitative information may be used to measure dynamic properties, such as the stiffness of the wall portion of the lower airways, or any other change in an airway calibre which is consequence of a disease such as asthma, emphysema and bronchiectasis.
  • dynamic manoeuvres such as deep breathing or coughing
  • conditions such as tracheo- bronchomalacia may be better characterised.
  • the present invention provides in a second aspect a method of characterising progression of a disease affecting the lower airways of a lung, the method comprising: providing quantitative information about a property of the lower airways at a first time using the method of in accordance with the first aspect of the present invention; providing quantitative information about the property of the lower airways at a second time using the method of in accordance with the first aspect of the present invention; and comparing the quantitative information provided at the first time with the quantitative information provided at the second time; wherein the comparison is indicative of progression of the disease.
  • the present invention provides in a third aspect a method of characterising response to treatment of a disease affecting the lower airways of a lung, the method comprising: providing quantitative information about a property of the lower airways using the method of in accordance with the first aspect of the present invention; thereafter providing treatment for the disease; thereafter providing quantitative information about the property of the lower airways at a second time using the method of in accordance with the first aspect of the present invention; and comparing the quantitative information provided before and after treatment; wherein the comparison is indicative of a response to the treatment .
  • Figure 1 shows a flow-chart of a method of providing quantitative information about a property of the lower airways of a lung according to an embodiment of the present invention
  • Figure 2 shows an anatomical optical coherence tomography probe in accordance with embodiments of the present invention
  • Figure 3 shows images taken using a method in accordance with the embodiments of the present invention.
  • Figure 4 illustrates a schematic instrumental set-up in accordance with a specific embodiment of the present invention.
  • Method 100 illustrated in Figure 1 comprises the step 102 of inserting an anatomical optical coherence tomography probe into the lower airways of a lung.
  • This step comprises directing a bronchoscope through the nose or mouth of a patient into the lower airways.
  • the probe is passed though the bronchoscope until a probe head has passed beyond an end of the bronchoscope. Positioning of the probe can be visualized on a monitor using the imaging capability of the bronchoscope.
  • FIG. 2 shows the anatomical optical coherence tomography probe.
  • the probe 200 comprises a probe head 202 that is arranged for emitting or receiving light that is provided by a suitable laser. Further, the probe 200 comprises a probe shaft 204. The probe 200 is arranged for rotation about an axis of the probe 200. It is to be appreciated by a person skilled in the art that alternatively the probe head 202 may be arranged for rotation relative to the probe shaft 204. Light is in use emitted and received from the probe head 202. In this embodiment the light has a wavelength of the order of 1310nm.
  • the probe 200 is arranged for detecting the tomography of an internal wall portion of the lower airways at a distance up to 10mm, 20mm, 30mm or 40mm or more.
  • the method 100 comprises the step 104 of directing suitable light to, and receiving reflective light from, an internal wall portion of the lower airways using the probe 200. Further, the method 100 comprises the step 106 of rotating the probe and moving the probe along a portion of the lower airways, such as a tubular portion. In this example the probe 200 is rotated at a frequency of 1-3Hz and moved along a selected tubular portion of the lower airways at a speed of 0.5-2mm/s.
  • Step 108 of the method 100 comprises determining a diameter of a section of the lower airway portion.
  • This step comprises processing phase information associated with a phase relation between the reflected light received by the probed head 202 and reference light.
  • the information is processed using principles of anatomical optical coherence tomography.
  • An instrumental set-up is illustrated will be described below with reference to Figure 4 and ror general principles on optical coherence tomography reference is being made to the following publication: Huang D et al, "Optical coherence tomography", Science 1991 Nov 22, 254 (5035) : 1178-81. It is to be appreciated that in variations of this embodiment the method 100 may comprise determining any other quantity associated with a property, such as a radius of a section of the lower airway portion.
  • the method 100 is conducted so that the internal tomography of the entire tubular portion, though which the probe head 202 of the probe 200 is moved, is recorded and any portion of the recorded tomography may be displayed on a monitor. Further, the method 100 is conducted so that the distance between any opposing portions of the determined internal topography can be determined.
  • a patient may have an obstruction in a lower airway portion of the lung.
  • the method 100 may be conducted so that the tomography of that airway portion is determined along the obstruction by moving the probe head 202 of the probe 200 from a region above the obstruction along the obstruction to a region below the obstruction. Imaging of the recorded tomography with dimensions provides an operator with valuable information about a change in diameter and length of the lesion.
  • Figure 3 shows an image of the topography of a section through a portion of the lower airways.
  • the image 300 shows a section of the internal wall portion 302 and was recorded using the method 100.
  • a recording 304 of the probe head 202 is shown in the centre of the image 300 .
  • a stent may have to be incorporated in order to widen a portion of the lower airways.
  • an operator can choose a stent size and a balloon pressure for incorporating the stent based on the provided information on the diameter and the change thereof .
  • the quantitative information may be used to determine an ideal stent size and balloon pressure for incorporating the stent.
  • the above-defined method has the significant advantage that quantitative data on the diameter of the airway portion can be provided within a very short period of time.
  • the probe 200 initially records data and provides images in substantially real time.
  • the quantitative information typically is provided within a few minutes after recording of the data, which enables selecting a suitable stent size and balloon diameter during the procedure so that the stent can be incorporated immediately. It is to be appreciated by a person skilled in the art that in variations of the described embodiment the quantitative information may also be provided in substantially real time.
  • the method 100 may be used for a variety of applications.
  • the method 100 may be used to monitor the topography of a region where tissue of a transplant is attached to native tissue. Further, the method 100 may be conducted during movement of the airways, such as during respiration of the patient. The obtained quantitative data can then be processed with or without simultaneously recorded measurements of airway pressure to provide information about the elasticity or stiffness of wall portions of the lower airways, which is of concern for a range of diseases such as asthma, emphysema, bronchiectasis and tracheo-bronchomalacia to name a few.
  • diseases such as asthma, emphysema, bronchiectasis and tracheo-bronchomalacia to name a few.
  • the airway properties obtained by this method may be used before and after therapeutic interventions to determine changes in airway properties which result from the intervention (or example, pre- and post-thermoplasty in asthmatic airways) .
  • Other examples include before and after provocation challenges, lung volume changes, posture changes etc.
  • the method 100 may be conducted using a variety of operation parameters, such as rotation frequencies of the probe and wavelength of the light.
  • FIG. 4 shows a schematic set-up of instrumentation used for operation of the above-described method in accordance with a specific embodiment of the present invention.
  • the instrumentation 350 comprises a suitable broad band light source 352 that is used to generate light to be directed to an internal wall portion of the lower airways and reference light. Further, the instrumentation 350 comprises polarization controllers 354, a phase modulator 356 and a frequency-domain optical delay line 358.
  • the instrumentation 350 comprises a fibre optic rotary joint 360 that is coupled to catheter probe 368, which includes the probe 202 shown in Figure 2.
  • the probe 202 is rotatable within a catheter and operation of the catheter probe 368 is controlled by computer 370.
  • the reference light and light received by the probe 202 is converted into electrical signals by converters 371 and then processed by signal processor 372, which is in communication with the computer 370.
  • the computer 370 comprises a display (not shown) for displaying generated data and images .
  • the invention may be used for characterising progression of a disease affecting the lower airways of a lung or for characterising response to treatment of a disease affecting the lower airways of a lung.
  • the quantitative information provided at at least two different times, eg before and after treatment, and information concerning progression of the disease or response to the treatment, respectively, can be derived from comparing the quantitative information obtained at the at least two different times.

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Abstract

The present disclosure provides a method of providing quantitative information about a property of the lower airways of a lung using optical coherence tomography. The method comprises inserting a probe head of an anatomical optical coherence tomography device into the lower airways. Further, the method comprises directing light to, and receiving reflected light from, an internal wall portion of the lower airways. The light is suitable for optical coherence tomography. An electronic signal indicative of a phase difference between reference light and the received light is then generated. In addition the method comprises determining a quantity associated with a property of the lower airways by processing the generated electronic signal using a computer and computer software when the probe is positioned in the lower airways.

Description

A METHOD OF PROVIDING QUANTITATIVE INFORMATION ABOUT THE
LOWER AIRWAYS OF A LUNG
Field of the Invention
The present invention broadly relates to a method of providing information about a quantitative property of the lower airways of a lung.
Background of the Invention
The lower airways of a lung are defined as the tracheobronchial tree below the level of the vocal cords. Lung diseases often affect the topography of portions of the internal walls of lower airways. Changes in dimension and even airway obstruction are a usual consequence.
Bronchoscopes are used to provide qualitative information of internal airway anatomy. A bronchoscope typically comprises a tube that is inserted through the nose or mouth into the airways of a patient . The bronchoscope has a tip that is arranged for imaging the airway from within the lumen and contains a working channel to allow passage of other instruments or a wire into the lower airways. For example, such a wire may be used to mark a position that is selected for insertion of a stent required for local widening of a narrowed airway segment .
Prior to stent deployment, the airway may be widened by inflating a balloon. The choice of a suitable balloon pressure and stent size is critical for successful widening of the airway and for maintenance of the patency of the airway. Unfortunately, objective assessment of the diameter of an airway segment is very difficult to achieve as bronchoscopic images are not quantitative. Consequently, stents, which are relatively expensive, are frequently displaced (if the stent is too small) or cause local damage (if the stent is too large) because of a discrepancy between actual and perceived airway diameter.
There is a need for technological advancement.
Summary of the Invention
The present invention provides in a first aspect a method of providing quantitative information about a property of the lower airways of a lung using optical coherence tomography, the method comprising: inserting a probe head of an anatomical optical coherence tomography device into the lower airways; directing light to, and receiving reflected light from, an internal wall portion of the lower airways, the light being suitable for optical coherence tomography,- generating an electronic signal indicative of a phase difference between reference light and the received light; and determining a quantity associated with the property of the lower airways by processing the generated electronic signal using a computer and computer software when the probe is positioned in the lower airways.
Embodiments of the above-defined method have the significant advantage that information about the quantity associated with the property, such as a diameter, of a portion of the lower airways can be provided during a procedure and while the probe is positioned in the lower airways. The method typically is conducted so that the quantity associated with the property is determined immediately after directing the light to, and receiving reflected light from, the internal wall portion of the lower airways. For example, the quantity associated with the property may be determined within less than 1, 2 or 3 minutes and may even be provided substantially in real time.
In one embodiment the method is conducted so that, at the time when the quantitative information is provided, further light is directed to, and reflected light received from, the internal wall portion of the lower airways to provide subsequently further quantitative information.
The step of directing light to, and receiving reflected light from, the internal wall portion of the lower airways typically comprises rotating the probe head, or the entire probe, about an axis. In this case the method typically comprises determining the topography of the section, typically for the entire section.
The step of determining the quantity associated with the property may comprise comprises selecting the property from one of a plurality of selectable properties . For example, the selected property may be the shortest diameter across a section of a portion of the lower airways .
The method may comprise moving the probe head along a tubular portion of the lower airways during rotation of the probe head. Further, the method may comprise determining an entire internal topography of the tubular portion of the lower airways .
The method may comprise selecting any opposing regions of the determined internal topography of the tubular portion and determining a distance between the selected opposing regions. In addition, the method may comprise determining a length of the tubular portion, for example, the length of a focal airway stenosis. Further, the method may comprise the additional step of determining a cross- sectional area of the portion of the lower airways. Multiple cross-sectional images may also be combined to provide a measurement of the volume of a specific segment of the airways .
Providing the quantitative information typically comprises displaying the information on a monitor, for example in the form of an image .
In one specific embodiment of the present invention the method comprises inserting the probe head into the lower airways of the lung with the aid of a bronchoscope .
Embodiments of the above-defined method provide the significant advantage that information concerning an internal diameter, and a change thereof, can be determined within a short period of time. For example, a stent may have to be inserted into an obstructed portion of the lower airways of a patient to widen that portion of the lower airways. As the method according to embodiments of the present invention provides accurate quantitative information within short period of time, selection of a suitable balloon pressure and stent size for immediate insertion of the stent is facilitated. For example, the method may be conducted so that initially data is obtained using the probe head and the quantitative information concerning the portion of the lower airways is provided within a few minutes or less . The stent may then be inserted immediately thereafter.
In one specific embodiment the method comprises determining the topography before (or above) and behind (or below) an obstruction of the portion of the lower airways . The obtained information about the determined topography may then be processed to predict a suitable stent size (diameter and length) and/or balloon pressure for incorporation of the stent into the portion of the lower airways.
Further, the above-defined method may be used for characterising the topography of a region where a transplanted airway is attached to a native airway portion of a patient. Narrowing of the lower airways at such a region is often a problem and embodiments of the above- defined method allow quantitative characterisation of such a narrowing .
The probe head typically is narrower than a bronchoscope and the step of inserting the probe head into the lower airways may comprise inserting the probe head through the bronchoscope (or any other tube facilitating passage into the lower airway such as an endotracheal tube) and further into the lower airways than the bronchoscope. Often bronchoscopes are too wide to investigate properties of the lower airways at a position past an obstruction and the method according the embodiments of the present invention has the significant practical advantage of being able to pass beyond the obstruction where the bronchoscope cannot pass .
Further, directing suitable light to, and receiving reflected light from, an internal wall portion of the lower airways may be conducted during movement of wall portions of the lower airways . The provided quantitative information may be used to measure dynamic properties, such as the stiffness of the wall portion of the lower airways, or any other change in an airway calibre which is consequence of a disease such as asthma, emphysema and bronchiectasis. Likewise, during dynamic manoeuvres such as deep breathing or coughing, conditions such as tracheo- bronchomalacia may be better characterised.
It is to be appreciated that in alternative variations the above-defined method may be used for any other suitable application.
The present invention provides in a second aspect a method of characterising progression of a disease affecting the lower airways of a lung, the method comprising: providing quantitative information about a property of the lower airways at a first time using the method of in accordance with the first aspect of the present invention; providing quantitative information about the property of the lower airways at a second time using the method of in accordance with the first aspect of the present invention; and comparing the quantitative information provided at the first time with the quantitative information provided at the second time; wherein the comparison is indicative of progression of the disease.
The present invention provides in a third aspect a method of characterising response to treatment of a disease affecting the lower airways of a lung, the method comprising: providing quantitative information about a property of the lower airways using the method of in accordance with the first aspect of the present invention; thereafter providing treatment for the disease; thereafter providing quantitative information about the property of the lower airways at a second time using the method of in accordance with the first aspect of the present invention; and comparing the quantitative information provided before and after treatment; wherein the comparison is indicative of a response to the treatment .
The invention will be more fully understood from the following description of specific embodiments of the invention. The description is provided with reference to the accompanying drawings .
Brief Description of the Drawings Figure 1 shows a flow-chart of a method of providing quantitative information about a property of the lower airways of a lung according to an embodiment of the present invention; Figure 2 shows an anatomical optical coherence tomography probe in accordance with embodiments of the present invention,
Figure 3 shows images taken using a method in accordance with the embodiments of the present invention, and
Figure 4 illustrates a schematic instrumental set-up in accordance with a specific embodiment of the present invention.
Detailed Description of Specific Embodiments
Referring initially to Figures 1 - 2, a method of providing quantitative information about a property of the lower airways of a lung according to an embodiment of the present invention is now described.
Method 100 illustrated in Figure 1 comprises the step 102 of inserting an anatomical optical coherence tomography probe into the lower airways of a lung. This step comprises directing a bronchoscope through the nose or mouth of a patient into the lower airways. The probe is passed though the bronchoscope until a probe head has passed beyond an end of the bronchoscope. Positioning of the probe can be visualized on a monitor using the imaging capability of the bronchoscope.
Figure 2 shows the anatomical optical coherence tomography probe. The probe 200 comprises a probe head 202 that is arranged for emitting or receiving light that is provided by a suitable laser. Further, the probe 200 comprises a probe shaft 204. The probe 200 is arranged for rotation about an axis of the probe 200. It is to be appreciated by a person skilled in the art that alternatively the probe head 202 may be arranged for rotation relative to the probe shaft 204. Light is in use emitted and received from the probe head 202. In this embodiment the light has a wavelength of the order of 1310nm. In this example, the probe 200 is arranged for detecting the tomography of an internal wall portion of the lower airways at a distance up to 10mm, 20mm, 30mm or 40mm or more.
The method 100 comprises the step 104 of directing suitable light to, and receiving reflective light from, an internal wall portion of the lower airways using the probe 200. Further, the method 100 comprises the step 106 of rotating the probe and moving the probe along a portion of the lower airways, such as a tubular portion. In this example the probe 200 is rotated at a frequency of 1-3Hz and moved along a selected tubular portion of the lower airways at a speed of 0.5-2mm/s.
Step 108 of the method 100 comprises determining a diameter of a section of the lower airway portion. This step comprises processing phase information associated with a phase relation between the reflected light received by the probed head 202 and reference light. The information is processed using principles of anatomical optical coherence tomography. An instrumental set-up is illustrated will be described below with reference to Figure 4 and ror general principles on optical coherence tomography reference is being made to the following publication: Huang D et al, "Optical coherence tomography", Science 1991 Nov 22, 254 (5035) : 1178-81. It is to be appreciated that in variations of this embodiment the method 100 may comprise determining any other quantity associated with a property, such as a radius of a section of the lower airway portion.
In this example, the method 100 is conducted so that the internal tomography of the entire tubular portion, though which the probe head 202 of the probe 200 is moved, is recorded and any portion of the recorded tomography may be displayed on a monitor. Further, the method 100 is conducted so that the distance between any opposing portions of the determined internal topography can be determined.
For example, a patient may have an obstruction in a lower airway portion of the lung. In this case the method 100 may be conducted so that the tomography of that airway portion is determined along the obstruction by moving the probe head 202 of the probe 200 from a region above the obstruction along the obstruction to a region below the obstruction. Imaging of the recorded tomography with dimensions provides an operator with valuable information about a change in diameter and length of the lesion.
Figure 3 shows an image of the topography of a section through a portion of the lower airways. The image 300 shows a section of the internal wall portion 302 and was recorded using the method 100. In the centre of the image 300 a recording 304 of the probe head 202 is shown.
For example, a stent may have to be incorporated in order to widen a portion of the lower airways. In this case an operator can choose a stent size and a balloon pressure for incorporating the stent based on the provided information on the diameter and the change thereof . The quantitative information may be used to determine an ideal stent size and balloon pressure for incorporating the stent.
The above-defined method has the significant advantage that quantitative data on the diameter of the airway portion can be provided within a very short period of time. In this example the probe 200 initially records data and provides images in substantially real time. The quantitative information typically is provided within a few minutes after recording of the data, which enables selecting a suitable stent size and balloon diameter during the procedure so that the stent can be incorporated immediately. It is to be appreciated by a person skilled in the art that in variations of the described embodiment the quantitative information may also be provided in substantially real time.
It is also to be appreciated by a person skilled in the art that the method 100 may be used for a variety of applications. For example, the method 100 may be used to monitor the topography of a region where tissue of a transplant is attached to native tissue. Further, the method 100 may be conducted during movement of the airways, such as during respiration of the patient. The obtained quantitative data can then be processed with or without simultaneously recorded measurements of airway pressure to provide information about the elasticity or stiffness of wall portions of the lower airways, which is of concern for a range of diseases such as asthma, emphysema, bronchiectasis and tracheo-bronchomalacia to name a few. Further, the airway properties obtained by this method may be used before and after therapeutic interventions to determine changes in airway properties which result from the intervention (or example, pre- and post-thermoplasty in asthmatic airways) . Other examples include before and after provocation challenges, lung volume changes, posture changes etc. Further, it is to be appreciated that the method 100 may be conducted using a variety of operation parameters, such as rotation frequencies of the probe and wavelength of the light.
Figure 4 shows a schematic set-up of instrumentation used for operation of the above-described method in accordance with a specific embodiment of the present invention. The instrumentation 350 comprises a suitable broad band light source 352 that is used to generate light to be directed to an internal wall portion of the lower airways and reference light. Further, the instrumentation 350 comprises polarization controllers 354, a phase modulator 356 and a frequency-domain optical delay line 358. In addition, the instrumentation 350 comprises a fibre optic rotary joint 360 that is coupled to catheter probe 368, which includes the probe 202 shown in Figure 2. The probe 202 is rotatable within a catheter and operation of the catheter probe 368 is controlled by computer 370. The reference light and light received by the probe 202 is converted into electrical signals by converters 371 and then processed by signal processor 372, which is in communication with the computer 370. The computer 370 comprises a display (not shown) for displaying generated data and images .
The reference that is being made to publication by Huang et al does not constitute an omission that that publication is a part of the common general knowledge in Australia or in any other country.
Although the invention has been described with reference to particular examples, it will be appreciated by those skilled in the art that the invention may be embodied in many other forms. For example, it is to be appreciated that the invention may be used for characterising progression of a disease affecting the lower airways of a lung or for characterising response to treatment of a disease affecting the lower airways of a lung. In either case is the quantitative information provided at at least two different times, eg before and after treatment, and information concerning progression of the disease or response to the treatment, respectively, can be derived from comparing the quantitative information obtained at the at least two different times.

Claims

The Claims :
1. A method of providing quantitative information about a property of the lower airways of a lung using optical coherence tomography, the method comprising: inserting a probe head of an anatomical optical coherence tomography device into the lower airways; directing light to, and receiving reflected light from, an internal wall portion of the lower airways, the light being suitable for optical coherence tomography; generating an electronic signal indicative of a phase difference between reference light and the received light; and determining a quantity associated with the property of the lower airways by processing the generated electronic signal using a computer and computer software when the probe is positioned in the lower airways.
2. The method of claim 1 wherein the method is conducted so that, at the time when the quantitative information is provided, further light is directed to, and reflected light received from, the internal wall portion of the lower airways to provide subsequently further quantitative information.
3. The method of claim 1 or 2 wherein the method is conducted so that the quantity associated with the property is determined within less than 3 minutes after directing the light to, and receiving reflected light from, an internal wall portion of the lower airways.
4. The method of any one of the preceding claims wherein the method is conducted so that the quantity associated with the property is determined within less than 1 minute after directing the suitable light to, and receiving reflected light from, an internal wall portion of the lower airways .
5. The method of any one of the preceding claims wherein the method is conducted so that the quantity associated with the property is accessible substantially in real time .
6. The method of any one of the preceding claims wherein the quantity associated with the property is a diameter.
7. The method of any one of the preceding claims wherein the step of determining the quantity associated with the property comprises selecting the property from one of a plurality of selectable properties.
8. The method of claim 7 wherein the, quantity associated with the property is the shortest diameter across a section of a portion of the lower airways.
9. The method of any one of the preceding claims wherein the step of directing light to, and receiving reflected light from, the internal wall portion of the lower airways comprises rotating the probe head about an axis during directing and receiving of the light.
10. The method of claim 9 comprising determining the topography of an entire section of a portion of the lower airways .
11. The method of any one of the preceding claims comprising moving the probe head along a tubular portion of the lower airways during rotation of the probe head.
12. The method of claim 11 comprising determining an internal topography of the tubular portion of the lower airways .
13. The method of claim 11 or 12 comprising selecting any opposing regions of the determined internal topography of the tubular portion and determining a distance between the selected opposing regions.
14. The method of claim 11 or 12 comprising determining a length of the tubular portion.
15. The method as claimed in any one of the preceding claims comprising determining an average cross -sectional area or volume of a portion of the lower airways.
16. The method of any one of the preceding claims comprising providing the quantitative information by displaying the information on a monitor.
17. The method of any one of the preceding claims comprising inserting the probe head into the lower airways of the lung with the aid of a bronchoscope .
18. The method of any one of the preceding claims comprising determining the topography before (or above) and behind (or below) an obstruction of the portion of the lower airways .
19. The method of claim 18 wherein the information about the determined topography is processed to predict a suitable stent size and/or balloon pressure for incorporation into the lower portion of the lower airways.
20. The method of any one of the preceding claims wherein directing light to, and receiving reflected light from, an internal wall portion of the lower airways is conducted during movement of wall portions of the lower airways.
21. The method of claim 20 comprising providing information on dynamic properties of the wall portion of the lower airways .
22. A method of characterising progression of a disease affecting the lower airways of a lung, the method comprising: providing quantitative information about a property of the lower airways at a first time using the method of any one of the preceding claims; providing quantitative information about the property of the lower airways at a second time using the method of any one of the preceding claims; and comparing the quantitative information provided at the first time with the quantitative information provided at the second time; wherein the comparison is indicative of progression of the disease.
23. A method of characterising response to treatment of a disease affecting the lower airways of a lung, the method comprising : providing quantitative information about a property of the lower airways using the method of any one of claims 1 to 21; thereafter providing treatment for the disease; thereafter providing quantitative information about the property of the lower airways at a second time using the method of any one of the preceding claims; and comparing the quantitative information provided before and after treatment; wherein the comparison is indicative of a response to the treatment .
PCT/AU2008/001648 2007-11-06 2008-11-06 A method of providing quantitative information about the lower airways of a lung WO2009059368A1 (en)

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Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007015051A2 (en) * 2005-07-30 2007-02-08 The University Hospital Of North Staffordshire Nhs Trust Improvements in and relating to optical coherence tomography

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007015051A2 (en) * 2005-07-30 2007-02-08 The University Hospital Of North Staffordshire Nhs Trust Improvements in and relating to optical coherence tomography

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Title
ARMSTRONG J.J ET AL.: "In vivo size and shape measurement of the human upper airway using endoscopic long-range optical coherence tomography", OPTICS EXPRESS, vol. 11, no. 15, 28 July 2003 (2003-07-28), pages 1817 - 1826 *
ARMSTRONG J.J ET AL.: "Quantitative Upper Airway Imaging with Anatomic Optical Coherence Tomography", AM J RESPIR CRIT CARE MED, vol. 173, 20 October 2005 (2005-10-20), pages 226 - 233 2006 *
HUANG ET AL.: "Optical Coherence Tomography", SCIENCE, vol. 254, 22 November 1991 (1991-11-22), pages 1178 - 1181 *
MCLAUGHLIN, R.A. ET AL.: "Applying anatomical optical coherence tomography to quantitative 3D imaging of the lower airway", OPTICS EXPRESS, vol. 16, no. 22, 15 October 2008 (2008-10-15), pages 17521 - 17529 *

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