Bronchoscopists face numerous challenges in the accurate diagnosis and staging of lung diseases. One difficulty is finding an appropriate route through the lung airways to the area of concern. Planning involves the careful examination of CT (computed tomography) scans, during which the bronchoscopist mentally reconstructs the three dimensional airway tree from the two dimensional images for later recall during the procedure. Not surprisingly, studies have shown that once past the main airway branches there can be significant confusion about the bronchoscope’s location and the path to follow to reach the target area.(1) Once successfully reaching the desired location in the airway, a tissue sample is traditionally collected using a needle that pierces the airway wall (transbronchial needle aspiration or TBNA). However, TBNA many times does not acquire the intact cell samples that are required to discriminate malignant from benign disease and that are required for a successful bronchoscopic procedure.(2)(3) More importantly, many physicians are hesitant to even perform TBNA because of the risk of bleeding should they puncture a blood vessel on the other side of the airway. They instead send patients to undergo more invasive procedures such as mediastinoscopy or trans-thoracic needle aspiration.
The LungPoint system supports the physician in both preparation for a bronchoscopic procedure, with an imaging and 3D simulation program, and guidance during the actual procedure. The software uses the patient’s CT scan to provide a realistic rendering of the airways and automatically generates a path to the selected target location(s). During bronchoscopy it provides a side-by-side view of the planned path and the actual location of the bronchoscope to accurately reaching targets.
Research shows that a large number of diagnostic bronchoscopies performed in the lung fail to reach designated targets, causing patients to endure repeat or additional procedures. There is clearly a strong clinical need for improved navigation in the lung, states Cary Cole, chief executive officer of Broncus. It is our hope that this new system will meet that need and do so in a cost-effective manner.
The LungPoint system finally makes bronchoscopy planning and navigation sensible and straightforward, states Rebecca Bascom, MD, MPH, and Professor of Medicine, Penn State University. The capacity to quickly plan a procedure and create visual guidance to a lesion could result in a safer procedure and might decrease the need for more invasive surgeries.
The LungPoint software can be used in combination with the Yield Mini Doppler System and the Yield Transbronchial Coring Needles. The first is a novel bronchoscopic ultrasound Doppler catheter that can detect blood flow behind the airway wall to help physicians avoid blood vessels during biopsy and other procedures. The handle includes actuation stops at 5 mm increments to control the needle penetration.
We want to advance the field of bronchoscopy by giving physicians innovative new tools to extend their practice, states Cary Cole. We’ve been very pleased to see the enthusiastic reception to these product lines.
The LungPoint system does not require any special fixtures or disposables and is based on new advanced image processing methods that were developed over a 10 year period. It runs on off-the-shelf PCs and can be configured with treatment planning and/or procedure navigation software. An early version of the virtual bronchoscopic navigation approach has previously been tested at Hershey Medical Center while the LungPoint system is beginning market evaluation at several prestigious hospitals in the US.
