# Novel Ultrasound Localization of Pulmonary Nodules during Video Assisted Thoracic Surgery to Improve Surgical Resection

> **NIH NIH R21** · NORTH CAROLINA STATE UNIVERSITY RALEIGH · 2020 · $159,685

## Abstract

ABSTRACT
The objective of this research is to develop and validate novel ultrasound-based methods for the detection and
localization of pulmonary nodules (PNs) during minimally invasive thoracic surgery - Video Assisted Thoracic
Surgery (VATS), and robotic surgery. Lung cancer is the leading cause of cancer deaths in the U.S., with over
220,000 new cases diagnosed each year. PNs are detected by Computerized Tomographic (CT) scanning.
VATS and robotic surgery are performed to resect a PN, for diagnosis and therapeutic purposes. However,
during the surgery, PNs can be extremely difficult to locate precisely. Small nodules are particularly difficult to
feel. Therefore, there is no guarantee that the nodule will be in the resected region of the lung parenchyma.
This results in positive margins and sometimes a complete miss of the tumor in the resected lung wedge.
Ultrasound is used as an imaging modality based on the ability to create an image because the sound waves
bounce back, often in a straight line. Ultrasound can reliably demonstrate gallstones, estimate the size of
abdominal aneurysms, and can visualize blood moving through cardiac chambers, the basis of
echocardiography. Exposure of lung tissue to ultrasound waves results in multiple scattering due to thousands
of air/liquid interfaces from air-filled alveoli and alveolar walls. The objective of this research is to develop novel
ultrasound sequences, specific to the lung, exploiting the very complex properties of ultrasound multiple
scattering in the lung parenchyma. Our approach is based on the following paradigm: Because PNs are not
filled with alveoli, they will not be responsible for as much multiple scattering as the normal parenchymal lung
tissue. We propose that mapping the amount of multiple scattering in lung parenchyma will enable us to map
and accurately localize PNs in real time. We will accomplish two aims. Specific Aim 1: To develop methods to
exploit multiple scattering of ultrasound waves applied to lung tissue to determine the location of PNs. We will
develop ultrasound sequences and signal processing methods to quantify the amount of multiple scattering
locally. Specific Aim 2: To image pulmonary nodules to facilitate accurate excision using ultrasound. Simulated
PNs will be excised using surgical staplers under ultrasound guidance to localize the PNs, create images by
mapping the multiple scattering patterns and image the staplers in relation to the simulated PNs. In the future,
the developed sequences will be implemented on an intravascular ultrasound probe placed through a flexible
bronchoscope into the pleural space, which will be used during minimally invasive surgery to locate and ensure
proper resection of PNs. This should reduce the duration and enhance the safety of the procedure. The
ultrasound signals will demonstrate the PN and its location relative to the closed stapler, reducing the
incidence of positive resection margins. This innovative new use for ultrasoun...

## Key facts

- **NIH application ID:** 9870900
- **Project number:** 5R21CA231503-02
- **Recipient organization:** NORTH CAROLINA STATE UNIVERSITY RALEIGH
- **Principal Investigator:** Thomas M. Egan
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $159,685
- **Award type:** 5
- **Project period:** 2019-05-15 → 2022-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9870900

## Citation

> US National Institutes of Health, RePORTER application 9870900, Novel Ultrasound Localization of Pulmonary Nodules during Video Assisted Thoracic Surgery to Improve Surgical Resection (5R21CA231503-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/9870900. Licensed CC0.

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