Abstract:
A system for navigating to a target, the system comprising an extended working channel having a lumen extending therethrough for receiving a tool, a computing device including a memory and at least one processor, a plurality of images stored in the memory, a program stored in the memory that, when executed by the at least one processor, presents a user interface. The user interface including, at least one image of the plurality of images depicting the target and a progression of the extended working channel through the airway, a probability treatment zone defining a probability distribution of a trajectory of the tool once deployed beyond an opening of the extended working channel displayed in the at least one image. The user interface is displayed on a display device.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/020,258 filed on Jul. 2, 2014, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to a system and method enabling navigation to a target outside of an airway, or to which access is otherwise limited and to systems and methods for assessing the ability of tools to reach the target. 
         [0004]    2. Description of Related Art 
         [0005]    A common device for inspecting and navigating the airway of a patient is a bronchoscope. Typically, the bronchoscope is inserted into a patient&#39;s airways through the patient&#39;s nose or mouth and can extend into the lungs of the patient. A typical bronchoscope includes an elongated flexible tube having an illumination assembly for illuminating the region distal to the bronchoscope&#39;s tip, an imaging assembly for providing a video image from the bronchoscope&#39;s tip, and a working channel through which instruments, e.g., diagnostic instruments such as biopsy tools, therapeutic instruments can be inserted. 
         [0006]    In navigating to a target, bronchoscopes, however, are limited in how far they may be advanced through the airways due to their size. Where the bronchoscope is too large to reach a target location deep in the lungs a clinician may utilize certain real-time imaging modalities such as fluoroscopy. Fluoroscopic images, while useful present certain drawbacks for navigation as it is often difficult to distinguish luminal passageways from solid tissue. Moreover, the images generated by the fluoroscope are two-dimensional whereas navigating the airways of a patient requires the ability to maneuver in three dimensions. 
         [0007]    To address these aforementioned issues, systems have been developed that enable the development of three-dimensional models of the airways or other luminal networks, typically from a series of computed tomography (CT) images. One such system has been developed as part of the ILOGIC® ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY® (ENB™), system currently sold by Covidien LP. The details of such a system are described in the commonly assigned U.S. Pat. No. 7,233,820 filed on Mar. 29, 2004 to Gilboa and entitled ENDOSCOPE STRUCTURES AND TECHNIQUES FOR NAVIGATING TO A TARGET IN BRANCHED STRUCTURE, the contents of which are incorporated herein by reference. 
         [0008]    While the system as described in U.S. Pat. No. 7,233,820 is quite capable, there is always a need for development of improvements and additions to such systems. 
         [0009]    In addition, during the performance of an ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY® (“ENB”) procedure using an electromagnetic navigation (“EMN”) system, a clinician may be required to navigate to a target outside of an airway (or to a target which access is otherwise limited) and during this navigation the catheter may have to be parked short of the target. This is done in preparation for insertion of an access tool or needle which may have to penetrate the airway wall in order to reach the target. It is very common for a user to prefer moving as close as possible to the target. However, this sometimes overlooks the factor of catheter orientation in relation to the target, which is of equal or greater importance to reaching the target, compared to the distance from the target. Furthermore, when an access tool, needle or biopsy tool is deployed out of the catheter, it may deflect due to tissue physiology or geometry, catheter bending or other reasons. 
         [0010]    To address this issue, the present disclosure is directed to systems and methods of assessing the ability of a tool to reach and interact with the target located outside of an airway, or to which access is otherwise limited, from a location inside of the airway and identifying optimal locations from which to achieve such access and interaction. 
       SUMMARY 
       [0011]    Provided in accordance with the present disclosure are a system and method for navigating to a target outside of an airway, or to which access is otherwise limited. 
         [0012]    An aspect of the present disclosure relates to a system for navigating to a target, the system comprising: an extended working channel defining a lumen extending therethrough for receiving a tool; a computing device including a memory and at least one processor; a plurality of images stored in the memory; a display device that displays a user interface; and a program stored in the memory that, when executed by the at least one processor, presents the user interface, the user interface including: at least one image of the plurality of images depicting the target and a progression of the extended working channel through the airway; and a probability treatment zone defining a probability distribution of a trajectory of the tool once deployed beyond an opening of the extended working channel displayed in the at least one image. 
         [0013]    In another aspect of the present disclosure, the user interface is configured to depict movement of the extended working channel allowing the user to position the probability treatment zone in an orientation so that at least a portion of the target is encompassed by the probability treatment zone. 
         [0014]    In another aspect of the present disclosure, the user interface is further configured to allow the user to display the probability treatment zone as a three-dimensional volumetric shape. 
         [0015]    In another aspect of the present disclosure, the user interface is configured such that an increase in a target volume inside the probability treatment zone indicates an increase in probability that the tool will interact with a portion of the target inside the probability treatment zone. 
         [0016]    In another aspect of the present disclosure, the user interface is configured such that a length of the probability treatment zone from the opening of the extended working channel corresponds to a maximum effective range the tool can be deployed beyond the opening of the extended working channel. 
         [0017]    In another aspect of the present disclosure, the user interface is further configured to allow the user to display the probability treatment zone as a two-dimensional shape. 
         [0018]    In another aspect of the present disclosure, the user interface is further configured to display the probability treatment zone with a first indicator, wherein the first indicator includes a status of an orientation of the tool with respect to the target and a second indicator, where the second indicator includes a status of a range of the tool with respect to the target. 
         [0019]    In another aspect of the present disclosure, when the portion of the target is encompassed by the probability treatment zone, the status of the first indicator changes indicate that the orientation of the tool allows the tool to interact with the target. 
         [0020]    In another aspect of the present disclosure, when the range from the opening of the extended working channel to the target is less than a maximum deployable range of the tool, the status of the second indicator changes to indicate that the range of the tool allows the tool to interact with the target. 
         [0021]    In another aspect of the present disclosure, the tool is selected from the group consisting of needle, an access tool, a biopsy tool, a therapeutic material application tool, and an ablation tool. 
         [0022]    In another aspect of the present disclosure, the probability treatment zone is adjusted based on the tool selected. 
         [0023]    Any of the above aspects and embodiments of the present disclosure may be combined without departing from the scope of the present disclosure. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0024]    Objects and features of the presently disclosed system and method will become apparent to those of ordinary skill in the art when descriptions of various embodiments thereof are read with reference to the accompanying drawings, wherein: 
           [0025]      FIG. 1  is a perspective view of an electromagnetic navigation system in accordance with the present disclosure; 
           [0026]      FIG. 2  is a schematic diagram of a workstation configured for use with the system of  FIG. 1 ; 
           [0027]      FIG. 3  is a flowchart illustrating a method for navigating to the location of a target outside of an airway, or to which access is otherwise limited, provided in accordance with the present disclosure; 
           [0028]      FIG. 4A  is an illustration of a probability treatment zone displayed as a three-dimensional shape; 
           [0029]      FIG. 4B  is another embodiment of an illustration of a probability treatment zone displayed as another three-dimensional shape; 
           [0030]      FIG. 4C  depicts two illustration of a probability treatment zone displayed as a two-dimensional shape; and 
           [0031]      FIG. 5 . is an illustration of a user interface of the workstation of  FIG. 1  and  FIG. 2  presenting multiple views of 3D models for navigating to a target location in accordance with the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0032]    The present disclosure is directed to a system and method of determining and displaying proximity to a target, and presenting a graphical display of an area a biopsy tool, or other surgical tool, might traverse if extended from an Extended Working Channel in the direction of the target. With such a system a clinician can determine whether a change of position is desirable or necessary prior to extracting a biopsy or treating the targeted tissue and have increased confidence that a biopsy taken or a treatment undertaken has been of the target and not tissue merely in the proximity of the target. 
         [0033]    An EMN procedure generally involves at least two phases: (1) planning a pathway to a target located within, or adjacent to, the patient&#39;s airways; and (2) navigating a probe to the target along the planned pathway. These phases are generally referred to as (1) “planning” and (2) “navigation.” The planning phase of an EMN procedure is more fully described in commonly-owned U.S. patent application Ser. Nos. 13/838,805; 13/838,997; and 13/839,224, all entitled “Pathway Planning System and Method,” filed on Mar. 15, 2013, by Baker, the entire contents of which are hereby incorporated by reference. 
         [0034]    Prior to the planning phase, the patient&#39;s lungs are imaged by, for example, a computed tomography (CT) scan, although additional applicable methods of imaging will be known to those skilled in the art. The image data assembled during the CT scan may then be stored in, for example, the Digital Imaging and Communications in Medicine (DICOM) format, although additional applicable formats will be known to those skilled in the art. The CT scan image data may then be loaded into a planning software application (“application”) to be used during the planning phase of the ENB procedure. 
         [0035]    With reference to  FIG. 1 , an EMN system  110  is provided in accordance with the present disclosure. One such ENM system is the ENB system currently sold by Covidien LP. Among other tasks that may be performed using EMN system  110  are planning a pathway to target tissue, navigating a positioning assembly to the target tissue, navigating a biopsy tool to the target tissue to obtain a tissue sample from the target tissue using the biopsy tool, and digitally marking the location where the tissue sample was obtained, and placing one or more echogenic markers at or around the target. 
         [0036]    EMN system  110  generally includes an operating table  140  configured to support a patient; a bronchoscope  150  configured for insertion through the patient&#39;s mouth and/or nose into the patient&#39;s airways; monitoring equipment  160  coupled to bronchoscope  150  for displaying video images received from bronchoscope  150 ; a tracking system  170  including a tracking module  172 , a plurality of reference sensors  174 , an electromagnetic field generator  176 ; and a workstation  180  including software and/or hardware used to facilitate pathway planning, identification of target tissue, navigation to target tissue, and digitally marking the biopsy location. 
         [0037]      FIG. 1  also depicts two types of catheter guide assemblies  100 ,  190 . Both catheter guide assemblies  100 ,  190  are usable with EMN system  110  and share a number of common components. Each catheter guide assembly  100 ,  190  include a handle  191 , which is connected to an extended working channel (EWC)  196 . The EWC  196  is sized for placement into the working channel of a bronchoscope  150 . In operation, a locatable guide  192 , including an electromagnetic (EM) sensor  194 , is inserted into EWC  196  and locked into position such that the sensor  194  extends a desired distance beyond the distal tip  193  of EWC  196 . The location of the EM sensor  194 , and therefore the distal end of EWC  196 , within an electromagnetic field generated by the electromagnetic field generator  176 , can be derived by the tracking module  172 , and the workstation  180 . Catheter guide assemblies  100 ,  190  have different operating mechanisms, but the handle  191  can be manipulated by rotation and compression to steer the distal tip  193  of locatable guide  192  inserted into EWC  196 . Catheter guide assembly  190  is currently marketed and sold by Covidien LP under the name SUPERDIMENSION® Procedure Kits, similarly catheter guide assembly  100  is currently sold by Covidien LP under the name EDGE™ Procedure Kits, both kits include the  191 , extended working channel  196 , and locatable guide  192 . For a more detailed description of the catheter guide assemblies  100 ,  190 , reference is made to commonly-owned U.S. patent application Ser. No. 13/836,203 filed on Mar. 15, 2013 by Ladtkow et al., the entire contents of which are hereby incorporated by reference. 
         [0038]    As illustrated in  FIG. 1 , the patient is shown lying on operating table  140  with bronchoscope  150  inserted through the patient&#39;s mouth and into the patient&#39;s airways. Bronchoscope  150  includes a source of illumination and a video imaging system (not explicitly shown) and is coupled to monitoring equipment  160 , e.g., a video display, for displaying the video images received from the video imaging system of bronchoscope  150 . 
         [0039]    Catheter guide assemblies  100 ,  190  including locatable guide  192  and EWC  196  are configured for insertion through a working channel of bronchoscope  50  into the patient&#39;s airways (although the catheter guide assemblies  100 ,  190  may alternatively be used without bronchoscope  50 ). The locatable guide  192  and EWC  196  are selectively lockable relative to one another via a locking mechanism  199 . A six degrees-of-freedom electromagnetic tracking system  170  (e.g., similar to those disclosed in U.S. Pat. No. 6,188,355 and published PCT Application Nos. WO 00/10456 and WO 01/67035, the entire contents of each of which is incorporated herein by reference, or any other suitable positioning measuring system), is utilized for performing navigation, although other configurations are also contemplated. Tracking system  170  is configured for use with catheter guide assemblies  100 ,  190  to track the position of the EM sensor  194  as it moves in conjunction with EWC  196  through the airways of the patient, as detailed below. 
         [0040]    As further shown in  FIG. 1 , electromagnetic field generator  176  is positioned beneath the patient. Electromagnetic field generator  176  and the plurality of reference sensors  174  are interconnected with tracking module  172 , which derives the location of each reference sensor  174  in six degrees of freedom. One or more of reference sensors  174  are attached to the chest of the patient. The six degrees of freedom coordinates of reference sensors  174  are sent to workstation  180 , which includes application  181  where data from sensors  174  is used to calculate a patient coordinate frame of reference. 
         [0041]    Further shown in  FIG. 1  is a catheter biopsy tool  102  that is insertable into catheter guide assemblies  100 ,  190  following navigation to a target and removal of locatable guide  192 . Biopsy tool  102  is used to collect one or more tissue sample from the target tissue. As detailed below, biopsy tool  102  is further configured for use in conjunction with tracking system  170  to facilitate navigation of biopsy tool  102  to the target tissue, tracking of a location of biopsy tool  102  as it is manipulated relative to the target tissue to obtain the tissue sample, and/or marking the location where the tissue sample was obtained. 
         [0042]    Although navigation is detailed above with respect to EM sensor  194  being included in locatable guide  192  it is also envisioned that EM sensor  194  may be embedded or incorporated within biopsy tool  102  where biopsy tool  102  may alternatively be utilized for navigation without need of locatable guide  192  or the necessary tool exchanges that use of locatable guide  192  requires. A variety of useable biopsy tools are described in U.S. Provisional Patent Application Nos. 61/906,732 and 61/906,762 both entitled DEVICES, SYSTEMS, AND METHODS FOR NAVIGATING A BIOPSY TOOL TO A TARGET LOCATION AND OBTAINING A TISSUE SAMPLE USING THE SAME, filed Nov. 20, 2013 and U.S. 
         [0043]    Provisional Patent Application No. 61/955,407 having the same title and filed Mar. 14, 2014, the entire contents of each of which are incorporated herein by reference and useable with EMN system  110  as described herein. 
         [0044]    During procedure planning, workstation  180  utilizes CT image data, or other image data in DICOM format, for generating and viewing a three-dimensional model (“3D model”) of the patient&#39;s airways. The 3D model and image data derived from the 3D model enables the identification of target tissue (automatically, semi-automatically or manually), and allows for the selection of a pathway through the patient&#39;s airways to the target tissue. More specifically, the CT scans are processed and assembled into a 3D volume, which is then utilized to generate the 3D model of the patient&#39;s airways. The 3D model may be presented on a display monitor  181  associated with workstation  180 , or in any other suitable fashion. Using workstation  180 , various slices of the 3D volume and views of the 3D model may be presented and/or may be manipulated by a clinician to facilitate identification of a target and selection of a suitable pathway through the patient&#39;s airways to access the target. The 3D model may also show marks of the locations where previous biopsies were performed, including the dates, times, and other identifying information regarding the tissue samples obtained. These marks may also be selected as the target to which a pathway can be planned. Once selected, the pathway is saved for use during the navigation procedure. 
         [0045]    During navigation, EM sensor  194 , in conjunction with tracking system  170 , enables tracking of EM sensor  94  and/or biopsy tool  102  as EM sensor  194  or biopsy tool  102  is advanced through the patient&#39;s airways. 
         [0046]    Turning now to  FIG. 2 , there is shown a system diagram of workstation  180 . Workstation  180  may include memory  202 , which further includes CT data  214  and application  181  including user interface  216 , processor  204 , display  206 , network interface  208 , input device  210 , and/or output module  212 . 
         [0047]    Referring now to  FIG. 3 , there is shown a flowchart of an example method for navigating to a target outside of an airway, or to which access is otherwise limited, during a procedure in accordance with the present disclosure. Prior to the start of navigation, the clinician loads a navigation plan including the 3D model of the lungs of the patient and the planned pathways to identified targets into a navigation application  181  from memory  202 , via network interface  208 , or a USB drive. An example of the navigation application can be found in commonly assigned U.S. Provisional Patent Application No. 62/020,240 filed Jul. 2, 2014 and entitled SYSTEM AND METHOD FOR NAVIGATING WITHIN THE LUNG, the entire contents of which are incorporated herein by reference. 
         [0048]    To perform automatic registration, the clinician advances bronchoscope  150 , locatable guide  192 , and EWC  196  into each region of the patient&#39;s airways in step S 300  until registration has occurred between the location of EM sensor  194  of locatable guide  192  and the 3D model and other data in the navigation plan. Details of this registration are set forth in Provisional Application 62/020,220 filed on Jul. 2, 2014 the contents of which are incorporated herein by reference. Alternative registration techniques including manual are possible and described in detail in U.S. Pat. No. 7,233,820 entitled “ENDOSCOPE STRUCTURES AND TECHNIQUES FOR NAVIGATING TO A TARGET IN BRANCHED STRUCTURE” the entire contents of which are incorporated herein by reference. 
         [0049]    Once registered, the clinician continues to navigate to a target following a pathway identified in the pathway plan at step S 302 . As EWC  196  and locatable guide  192  approach the target, the clinician either manually enables or the application automatically enables a display of the model of the probability treatment zone (“PTZ”)  404  at step S 304 . Once enabled, the clinician navigates EWC  196  with respect to the target  403 , as shown in  FIG. 5 . As the clinician, following the pathway plan, approaches the target  403 , EWC  196  can be positioned such that the display of PTZ  404  interacts with the display target  403 . Specifically, the clinician navigates EWC  196  such that PTZ  404  encompasses a sufficient portion of the target  403  that the clinician can have reasonable certainty that biopsy or treatment deployed will properly impact the target  403  and not surrounding tissue, at steps S 306 , S 308 , and S 310 . The clinician has the ability to reposition the EWC  196 , at step S 310 , to further ensure that an increased amount of PTZ  404  encompasses target  403 . The clinician, through the repositioning of the EWC  196  in relation to the target  404 , thus repositions PTZ  404 . Once satisfied with the position of PTZ  404  with respect to target  403 , the clinician may optionally mark the position and orientation of the EWC  196 , at step S 312 . The locatable guide  192  (if used) may be removed at step S 314 , and a biopsy or treatment tool inserted through EWC  196  at step  316 , to perform the necessary biopsy or treatment at step S 318 . 
         [0050]    Referring now to  FIG. 4A , PTZ  404  is depicted as a three-dimensional volumetric shape. In this instance by a cone shaped projection emanating from the center point of distal tip  193  of EWC  196  or locatable guide  192 . The cone length L indicates the maximum useful or effective distance a laparoscopic tool (e.g., a biopsy tool, a microwave or radiation ablation tool, a chemotherapy tool, a therapeutic medication application tool, a brachytherapy tool, a marker placement tool, or other similar laparoscopic tools) can extend beyond the distal end of EWC  196 . The cone diameter D indicates the maximum probable distribution or deflection of a tool when extended beyond EWC  196 . As will be appreciated by those of skill in the art, the maximum length for which the tool is useful or effective may vary depending on the tool employed, and a selection feature may be enabled on the user interface of the navigation application to vary the length of the cone. Although shown as a conical overlay deploying beyond EWC  192  opening, PTZ  404  may be configured to have various shapes depending on physical attributes of the tool being employed. 
         [0051]    In  FIG. 4B , PTZ  404  is depicted as a three-dimensional volumetric cone shaped projection with a spherical cap emanating from the center point of distal tip  193  of EWC  196  or locatable guide  192 . The depiction in  FIG. 4B  details the use of a therapeutic medication application tool. The cone shaped projection with a spherical cap (or other applicable shape) indicates the maximum probable distribution of a therapeutic medication which is distributed beyond the distal end of EWC  196 . In one such embodiment, the therapeutic medication exits the distal tip  193  of EWC  196  or locatable guide  192  in a three-dimensional volumetric small cone shape followed by forming a volumetric spherical shape as the therapeutic medication continues to be dispersed. Although the therapeutic medication may continue to be distributed beyond the volumetric shape shown in  FIG. 4B  the volumetric shape details the maximum volume for which the therapeutic medication is useful or effective. 
         [0052]      FIG. 4C  shows a comparison of two projections viewed from EWC  196 , a cone  404  similar to that in  FIG. 4A  and an unbalanced ellipsoid  406 . As will be appreciated by those of skill in the art the unbalanced ellipsoid may represent the deflection of a tool which flexes in one direction more than in others. 
         [0053]    In a further embodiment, PTZ  404  may have different colors, and may change color as more of the target  403  is within PTZ  404 . Thus, the clinician is provided feedback regarding the sufficiency of the coverage of target  403 , within PTZ  404 , and can have greater confidence of reaching the target  403  as PTZ  404  changes from a red color indicating too little or no target  403  in PTZ  404 , to green indicating that greater than some threshold portion of the target  403  is within PTZ  404 . 
         [0054]    In addition, PTZ  404  may contain various indicators which enable the clinician to determine both the distance to target  403  and the orientation of distal tip  193  of EWC  196  with respect to target  403 . Indicators may include visual, tactile, or audio changes to indicate to the clinician that distal tip  193  of EWC  196  is in a position and orientation which allows the tool to interact with the target  403 . For example, as PTZ  404  is manipulated to a view as shown in  FIG. 4C , statuses of indicators may change to ensure that the distance L (shown in  FIG. 4A ) is better understood. Once the distance L is greater than the distance from distal tip  193  of EWC  196  to target  403 , the status of the indicators changes to notify the clinician that that target  403  is within PTZ  404 . 
         [0055]    In accordance with embodiments of the present disclosure, once registration is complete, display  181  presents user interface  500  to the clinician with a number of views  502 ,  504 , and  506 , as shown in  FIG. 5  to assist the clinician in navigating locatable guide  192  and EWC  196  to the target  403 . User interface  500  may include a local view (3D map static)  502 , a virtual bronchoscope view  504 , and a 3D map dynamic view  506 . Local view  502  also presents the clinician with a visualization of the distal tip  193  and EM sensor  194  of locatable guide  192 . Other views may be presented without departing from the scope of the present disclosure. As EWC  196  and locatable guide  192  advance, each of the views  502 ,  504 , and  506  is updated to account for the change in location. 
         [0056]    As shown in  FIG. 5 , PTZ  404  may be a graphic overlay applied by the navigation application when EWC  196  is in proximity of the target  403 , the target  403  having been identified by the clinician during the pathway planning phase of the procedure, described above. The PTZ  404  may be presented in any of the views depicted on user interface  500  to assist in the final orientation of EWC  196 . As noted above, the user interface  500  may include a user active Enable Probability Treatment Zone View button  516  allowing the clinician to display the  404  PTZ in any view depicted on the user interface  500 . In some embodiments this may be particularly useful in 3D viewing modes such the 3D map and/or virtual bronchoscopy view  504 . 
         [0057]    Referring back to the computer-readable media of  FIG. 2 , memory  202  includes any non-transitory computer-readable storage media for storing data and/or software that is executable by processor  204  and which controls the operation of workstation  80 . In an embodiment, memory  202  may include one or more solid-state storage devices such as flash memory chips. Alternatively or in addition to the one or more solid-state storage devices, memory  202  may include one or more mass storage devices connected to the processor  204  through a mass storage controller (not shown) and a communications bus (not shown). Although the description of computer-readable media contained herein refers to a solid-state storage, it should be appreciated by those skilled in the art that computer-readable storage media can be any available media that can be accessed by the processor  204 . That is, computer readable storage media includes non-transitory, volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information such as computer-readable instructions, data structures, program modules or other data. For example, computer-readable storage media includes RAM, ROM, EPROM, EEPROM, flash memory or other solid state memory technology, CD-ROM, DVD, Blu-Ray or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by workstation  180 . 
         [0058]    Further aspects of the system and method are described in co-pending and commonly-owned U.S. Provisional Patent Application Ser. No. 62/020,220 entitled “Real-Time Automatic Registration Feedback,” filed on Jul. 2, 2014, by Brown et al.; U.S. Provisional Patent Application Ser. No. 62/020,177 entitled “Methods for Marking Biopsy Location,” filed on Jul. 2, 2014, by Brown; U.S. Provisional Patent Application Ser. No. 62/020,240 entitled “System and Method for Navigating Within the Lung,” filed on Jul. 2, 2014, by Brown et al.; U.S. Provisional Patent Application Ser. No. 62/020,238 entitled “Intelligent Display,” filed on Jul. 2, 2014, by Kehat et al.; U.S. Provisional Patent Application Ser. No. 62/020,242 entitled “Unified Coordinate System for Multiple CT Scans of Patient Lungs,” filed on Jul. 2, 2014, by Greenburg; U.S. Provisional Patent Application Ser. No. 62/020,245 entitled “Alignment CT,” filed on Jul. 2, 2014, by Klein et al.; U.S. Provisional Patent Application Ser. No. 62/020,250 entitled “Algorithm for Fluoroscopic Pose Estimation,” filed on Jul. 2, 2014, by Merlet; U.S. Provisional Patent Application Ser. No. 62/020,261 entitled “System and Method for Segmentation of Lung,” filed on Jul. 2, 2014, by Markov et al.; U.S. Provisional Patent Application Ser. No. 62/020,253 entitled “Trachea Marking,” filed on Jul. 2, 2014, by Lachmanovich et al.; and U.S. Provisional Patent Application Ser. No. 62/020,262 entitled “Dynamic 3D Lung Map View for Tool Navigation Inside the Lung,” filed on Jul. 2, 2014, by Weingarten et al., the entire contents of all of which are hereby incorporated by reference. 
         [0059]    Detailed embodiments of devices, systems incorporating such devices, and methods using the same have been described herein. However, these detailed embodiments are merely examples of the disclosure, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for allowing one skilled in the art to variously employ the present disclosure in virtually any appropriately detailed structure. While the preceding embodiments were described in terms of bronchoscopy of a patient&#39;s airways, those skilled in the art will realize that the same or similar devices, systems, and methods may be used in other lumen networks, such as, for example, the vascular, lymphatic, and/or gastrointestinal networks as well.