ABSTRACT The recent expansion of lung cancer screening programs in the United States has led to a significant increase in the number of lung lesions requiring sampling to evaluate their malignancy status. Bronchoscopic based peripheral lung biopsy offers the lowest rate of procedural complication. However, diagnostic yields have remained moderate, primarily due to the lack of high resolution, real-time imaging guidance. Techniques such as endobronchial ultrasound and electromagnetic navigational bronchoscopy offer some guidance for the interventionalist, but remain limited for the necessary fine localization of the biopsy needle tip and lesion just prior to sampling. Standard CT based imaging approaches are too expensive and cumbersome for intra- procedural use. We have developed a stationary digital chest tomosynthesis imaging approach based on the linear x-ray array based on the carbon nanotube field emission sources. Our approach offers the potential for rapid, high resolution in-plane imaging combined with low-dose stereoscopic imaging, all without the need for any physical motion of the x-ray source or detector. We seek to refine our stationary chest tomosynthesis system, evaluate rapid CT to tomosynthesis image registration techniques and integrate the software control and guidance system in a system for pre-clinical large animal evaluation. Our academic-industrial partnership will incorporate a team of physicists, computer scientists, radiologists and interventional pulmonologists to develop this system.

PROJECT NARRATIVE Navigational bronchoscopy of lung lesions offers the lowest complication rate, but reduced success rates due to the limited ability to localize and visualize lesions. We have developed a new imaging system, stationary digital chest tomosynthesis, which will allow both image guidance for navigation and enhanced lesion visualization. The goal of this study is to evaluate the system for the evaluation of stationary chest tomosynthesis for use in image guided bronchoscopy biopsies.