'This is the most exciting technology I've seen come along in bronchoscopy in 30 years," says Dr. Kenneth B. Smith, a pulmonologist at East Jefferson General Hospital (EJGH). He is the only doctor in the New Orleans area who is using the inReach system.
Smith, who learned of the system during a conference, attended intensive hands-on training for the system at Emory University and at the SuperDimension headquarters in Minnesota. He began performing electromagnetic navigational bronchoscopies at EJGH earlier this year.
'We start by taking a specially formatted CT scan of the patient's chest," he says. "The system then creates a virtual image based on that scan, a virtual "roadmap' of the lungs and bronchial tubes through which one can navigate directly to the abnormality. We then merge the virtual image with the actual real-time images so you are assured you are in the right place."
The system uses electromagnetic localization to guide the physician as they navigate through the patient's bronchial tubes to the targeted abnormality. "It's used almost like a GPS system to find lesions that would normally be beyond the view of a bronchoscope," says Pam Jamison, a respiratory therapist at EJGH for the past 19 years and Dr. Smith's assistant during the procedures.
One of the main benefits of using the system is the ability to collect a better and more accurate tissue sample for the pathologist to examine, which leads to a more accurate diagnosis.
'Based on the research at other facilities, this system leads to 50 percent more accurate diagnoses in lung cancer," Jamison says. With this improved accuracy, the system provides a faster and more definitive diagnosis. Detecting cancer at an earlier stage can significantly increase the chances for a positive outcome for the patient.
Previously, when an area of the lungs was beyond the reach of a traditional bronchoscope, a physician would have to use a more invasive procedure such as a needle biopsy through the wall of the chest, or even surgery, to take a tissue sample, both of which can lead to complications.
'From a safety standpoint, the electromagnetic navigational bronchoscopy is a much safer procedure than having to go through the chest wall with a needle," says Ken Duet, director of pulmonary services at EJGH. "Although it's uncommon, there is a much greater potential for the lung to collapse with a needle biopsy than with a biopsy obtained through a bronchoscope."
'This system gives us the ability to localize the mass," Duet says. "Another benefit is that it's a multidisciplinary tool for diagnosis. It involves the lab, radiology, pulmonology. It was just a happy coincidence that this technology coincided with the hospital's affiliation with M. D. Anderson Physicians Network, giving the oncologists another tool in their diagnostic arsenal."
The navigational system also can be used for taking biopsies of mediastinal lymph nodes, which run along the outside of the windpipe and bronchial tubes and are often the first place cancer spreads.
'If the lymph nodes in this area are enlarged and need further exploration, navigational bronchoscopy allows us to do so without resorting to a surgical procedure involving an incision across the lower neck," Smith says. "There's actually no incision at all."
The less-invasive nature of the electromagnetic navigational bronchoscopy leads to shorter recovery times and less trauma to the patient. Smith says patients are sedated during the procedure, and therefore the most discomfort they generally feel is minor coughing or a mild sore throat afterwards.
The nonprofit EJGH Foundation, which often assists the hospital in acquiring cutting-edge technologies, helped to purchase the system. "Had it not been for the foundation's gracious funding arm, we couldn't have purchased this technology," Smith says.