A Cyber-Physical System for Unified Diagnosis and Treatment of Lung Diseases

In this research, I will develop a cyber-physical system (CPS) for the diagnosis and treatment of lung diseases. My project is motivated by three facts: 1) Lung cancer treatment is most successful when it is found at an early stage. Treatment of early-stage cancer offers 73% chance of survival, whereas in late-stage this is reduced to 13%. However, the current methods for early diagnosis of peripheral lung lesions using bronchoscopic biopsy are challenging with varying diagnostic yield. Thus, there is a need to develop new technologies for reliable diagnosis of cancer in the lung periphery. 2) At present, surgical resection of malignant nodules (Tumours<3cm diameter) in the lung is the treatment modality of choice. However, most patients are not suitable surgical candidates, thus prompting the need for other therapeutic options. An emerging less invasive treatment option is bronchoscopic ablation of lung cancer via delivering physical therapy to lesions in the lung (cryotherapy/photonic ablation). Bronchoscopic ablation is not widely used to treat lung cancer, primarily due to the limited depth of penetration and small range of motion of the bronchoscope. 3) The overall in-hospital mortality rate for patients in ICU with ventilator associated events approaches 30%. New pulmonary infiltrates are a diagnostic challenge and due to the poor sampling methods available, patients are often initiated on non-targeted therapies. Bronchoscopy and sampling of the distal lung in diffuse diseases is not standardised and lacks repeatability and requires expert operators. The key aim of this research is to democratise ICU bronchoscopy and develop a platform using vision computing, EMT and external registration to enable non-skilled operators to sense, sample and diagnose pathology in vivo in situ. To this end, I propose a CPS that addresses the unique issues of bronchoscopic diagnosis and treatment of lung diseases using novel mechatronic systems, control algorithms, and image guidance. The CPS has the potential to deliver unified diagnosis and treatment platform for early-stage lung cancer and on-site differential diagnosis of diffuse lung diseases by enhancing the current bronchoscopic technology in two specific ways: 1) Manipulation augmentation: I will design and develop a mechatronic device comprised of an active mini-bronch and a user interface for steering. The active mini-bronch is made of a flexible robot equipped with an endoscopic camera, fibre-optics for molecular imaging/sensing of tissue. It also provides a working channel that can be used for ablation of cancerous tissue or tissue sampling. The proposed mechatronic device can be used in two scenarios: (1) Autonomous tissue sampling in intensive care units: The mini-bronch uses control algorithms to navigate to lung subsegments and take multiple samples for diagnosis, (2) Semi-autonomous tissue diagnosis/treatment: the operator uses the user interface to navigate the mini-bronch to the periphery of the lung, characterise, sample and detect cancerous tissue, and then ablate . My control algorithms will provide unprecedented capabilities in terms of dexterity, safety, and ease of operation. 2) Visual augmentation: A key goal is to develop algorithms that employ emerging molecular imaging techniques to provide an imaging technology for in-vivo diagnosis of lung diseases. I postulate that the proposed CPS will enable rapid on-site evaluation of lung diseases and successful bronchoscopic detection and therapy.