Clinical suites

All-in-one diagnosis and treatment of lung cancer


Lung suite

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Lung suite is an innovative, real-time and integrated cone beam CT imaging and navigation platform for bronchoscopic, percutaneous and surgical procedures.

Based on simulation results and published clinical studies

100%


Lung tumor depiction using high-quality Cone Beam CT2,3,4 

Accuracy


High diagnostic accuracy for both percutaneous and endobronchial approach2,3,4

iVATS


Proven ability to combine tumor marking and VATS resection in single room5

96%


are satisfied with Azurion's ease of use1

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Our solutions

XperCT Dual

Excellent cone beam CT for lung cancer treatments

XperCT Dual

XperGuide Ablation

Planning and guidance for percutaneous biopsy, marking and ablative therapy

XperGuide Ablation

Dynamic 3D Roadmap

with tumor segmentation, 3D navigation support for endobronchial procedures

Dynamic 3D Roadmap

Case Study  

Cone Beam CT guided endobronchial biopsy
assisted by 3D live fluoroscopy overlay with tumor segmentation

Patient history

This is a 54 y.o. female presenting with a 10 mm lesion in the left lower lobe (Figure 1). She was a non-smoker and had a history of breast cancer. She was scheduled forendobronchial biopsy to achieve adequate tissue sampling for pathology analysis and diagnosis.

 

Procedure

Subsequent to patient intubation, the ceiling mounted C-arm system (Allura Xper FD20, Philips) was positioned on the left side of the patient, centering the field of view of the detector to include both lungs. Cone Beam CT data (XperCT, Philips) was acquired during an 8-second roll protocol, while temporarily suspending mechanical ventilation. Using the Cone Beam CT data, the lung nodule was highlighted by the physician using commercially available software (Lung suite, Philips)* during a process known as segmentation. During the biopsy procedure, this 3D nodule segmentation was visualized in an overlay with live fluoroscopy (3D Roadmap, Philips) parallel to standard fluoroscopy imaging and electromagnetic navigation bronchoscopy (ENB) (SuperDimension, Medtronic) (Figure 2). This was particularly critical in this patient as the lesion was fluoroscopically invisible. Geometric correspondence of live fluoroscopy and 3D tumor segmentation was maintained throughout the case while manipulating C-arm angulation, table position, and image-zoom settings.

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary. 
* Lung suite is the combination of our XperCT Dual, XperGuide Ablation and Dynamic 3D Roadmap solutions

Subsequent to lesion segmentation, an Olympus BF-P180 bronchoscope (Tokyo, Japan) was introduced into the airway. A curved steerable catheter (Edge Firm Tip, Medtronic) was inserted into the working channel and then navigated to the lesion using the ENB system. After navigating close to the lesion, fluoroscopy was used as usual but showing the segmented lesion overlaid on the regular fluoroscopic image. Final catheter position was then verified in multiple planes (i.e. LAO, RAO, and 90 degrees lateral) with 3D live fluoroscopy overlay and confirmed with an additional Cone Beam CT scan. Tissue samples were obtained using multiple biopsy tools with rapid on-site pathologic examination (ROSE). ROSE was consistent with adenocarcinoma and this was suspicious for primary lung cancer, despite her non-smoking status. Final pathologic examination determined this was indeed a primary lung cancer based on immunohistochemistry. She went on to have a left lower lobectomy for her primary lung cancer. She continues to do well and has no evidence of recurrence of her breast or lung cancers.
Michael Pritchett

Dr. Michael Pritchett

is a pulmonologist and Director of the Chest Center of the Carolinas, and is affiliated with FirstHealth Moore Regional Hospital and Pinehurst Medical Clinic. He is one of the pioneers in the use of Cone Beam CT imaging and augmented fluoroscopy during endobronchial procedures.
Diagnostic MDCT
Figure 1: Pre-operative CT (Brilliance CT 64 slice, Philips) shows small pulmonary lesion in the left lower lobe.
Standard & Augmented Fluoroscopy
Figure 2: Comparison of standard fluoroscopy (left) and 3D live fluoroscopy overlay with tumor segmentation (right) for this fluoroscopically invisible nodule. The blue volume was segmented from Cone Beam CT data and automatically projected using dedicated software (Lung suite, Philips).

Conclusion

 

Intra-procedural Cone Beam CT imaging with 3D live fluoroscopy overlay is feasible and effective in achieving high diagnostic yield during endobronchial biopsy procedures. As the field of bronchoscopy advances towards therapeutics there will be increased demand for high-yield bronchoscopic biopsy techniques. Additionally for anyone considering the future application of endobronchial microwave ablation, Cone Beam CT scanning will most likely be required to confirm placement of the probe in the center of the lesion. Collaborative efforts focused around the lung cancer patient should be considered to initiate cross-discipline programs and open the doors of Cone Beam CT systems to pulmonary specialists.

What do your peers say about Cone Beam CT in a Hybrid OR?

k-lau-desktop
Use of CBCT in hybrid OR provides us with a reliable and accurate method for intraoperative localization of small pulmonary nodules. This is the next step in the evolution of thoracic surgery."

Dr. K. Lau, Barts Health NHS Trust, St. Bartholomew’s Hospital, London, UK

Michael Pritchett
Cone Beam CT offers the distinct advantage of intra-procedural real-time imaging; it gives us greater confidence and is a must for future ablative technologies that use an endobronchial approach.”

Dr. M. Pritchett, DO, MPH FirstHealth Moore Regional Hospital, Pinehurst, NC, USA

Related clinical publications

Prospective randomized trial for image-guided biopsy using cone-beam ct navigation compared with conventional ct
A systematic review and meta-analysis of c-arm cone-beam ct-guided percutaneous transthoracic needle biopsy of lung nodules
Cone beam ct-guided endobronchial biopsy assisted by augmented fluoroscopy
Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery

Related solutions & products

  • Azurion 7 C20 & Azurion 7 F20

    Azurion 7 C20 & Azurion 7 F20

    Move to a hybrid suite with confidence with the Azurion 7 with 20'' flat detector.

  • AlluraClarity with ClarityIQ technology

    AlluraClarity with ClarityIQ technology

    See with confidence - every time

References

 
  1. Results obtained during user tests performed in the period of November 2015-February 2016. The tests were designed and supervised by Use-Lab GmbH, an independent and objective usability testing engineering consultancy and user interface design company. The tests involved 31 US-based clinicians (16 physicians and 15 technicians) and 30 European-based clinicians (15 physicians and 15 technologists), who performed procedures using Azurion in a simulated interventional lab environment. 
  2. Abi-Jaoudeh, Nadine, et al. “Prospective randomized trial for image-guided biopsy using cone-beam CT navigation compared with conventional CT.” Journal of Vascular and Interventional Radiology 27.9 (2016): 1342-1349. 
  3. Yan, Gao-Wu, et al. “A systematic review and meta-analysis of C-Arm Cone-Beam CT-guided percutaneous transthoracic needle biopsy of lung nodules.” Polish journal of radiology 82 (2017): 152.
  4. Pritchett, Michael, et al. “Cone Beam CT-Guided Endobronchial Biopsy Assisted by Augmented Fluoroscopy.” Chest 152.4 (2017): A887. 
  5. Zhao, Ze-Rui, Rainbow WH Lau, and Calvin SH Ng. “Hybrid theatre and alternative localization techniques in conventional and single-port video-assisted thoracoscopic surgery.” Journal of thoracic disease 8.Suppl 3 (2016): S319.

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