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Join online session of Dr. Erik van der Heijden and Dr. Wolfgang Hohenforst-Schmidt on Cone beam CT and real time imaging for accurate diagnosis and treatment.
Date: October 8th
Time: 02:10pm – 03:10pm
XperCT Dual
Excellent cone beam CT for lung cancer treatments
XperGuide Ablation
Planning and guidance for percutaneous biopsy, marking and ablative therapy
Dynamic 3D Roadmap
with tumor segmentation, 3D navigation support for endobronchial procedures
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
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.
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
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
Azurion 7 C20 & Azurion 7 F20
Move to a hybrid suite with confidence with the Azurion 7 with 20'' flat detector.