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Radiation Dose to Patients and Clinicians During Biopsy of Peripheral Pulmonary Lesions Guided by Augmented Fluoroscopy
Description
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A6151 - Radiation Dose to Patients and Clinicians During Biopsy of Peripheral Pulmonary Lesions Guided by Augmented Fluoroscopy
Author Block: K. Bhadra; CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN, United States.
Background: Fluoroscopic guided transbronchial biopsy for peripheral pulmonary nodules has several limitations including low diagnostic yield. The novel augmented fluoroscopy platform (LungVision, Body Vision Medical Ltd, Israel) integrates existing imaging devices in the operating space into an intuitive fluoroscopic display, providing greater accuracy, visualization and navigation experience than existing virtual bronchoscopic methods. Appreciating the benefits of this innovative technology, the objective of this study is to determine the patient’s and clinician’s radiation exposure during diagnostic endobronchial procedure guided by augmented fluoroscopy.
Methods:
Patients with pulmonary nodules referred for bronchoscopy were included in the study. CT scans were imported into the LungVision planning software, where physicians identified the target nodules and selected the desired pathways. LungVision system was used for real-time localization of the airways and lesion and for directional guidance during biopsy. Using a flexible bronchoscope, a fluoroscopically visible, steerable catheter was introduced through the working channel. The catheter was guided to the target by following a dynamically adjusting pathway over the fluoroscopy image. When the nodule had been reached, a radial EBUS probe was advanced down the catheter and LungVision system recorded fluoroscopy and radial EBUS images. Finally, tissue samples were taken utilizing augmented flouroscopic images. The radiation time and dose were recorded per each navigation procedure. The patient effective radiation dose was calculated using random sampling computer simulation model. Passive personal film dosimeters were placed on the pulmonologist.
Results: 30 patients were recruited to the study. Average lesion size was 29mm±STD (range 7-70mm). No adverse events were reported. Lesion location was verified successfully by radial EBUS in all (100%) cases. Tissue samples were successfully acquired under augmented fluoroscopic and ultrasonic image guidance and recorded diagnostic yield was 73%. The mean fluoroscopy screening time was 3.3± STD min. A median effective radiation dose of 0.65 ± STD milli-Sieverts (mSv) (range 0.16 -1.7 mSv) was received by Patients. The film dosimeters worn on clinicians’ protective cloth recorded measurable radiation doses. Based on attenuation properties of the protective outfits, it has been estimated that the effective radiation dose per procedure to the staff member was 0.0004 mSv or less.
Conclusion: The novel approach of combined augmented endobronchial fluoroscopic and ultrasonic navigation and guidance is safe, feasible and accurate for real time nodule diagnosis. A notable increase of diagnostic yield was observed. Any concern of patient’s radiation exposure should not preclude the use of augmented fluoroscopy in diagnostic bronchoscopy if clinically indicated.
Author Block: K. Bhadra; CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN, United States.
Background: Fluoroscopic guided transbronchial biopsy for peripheral pulmonary nodules has several limitations including low diagnostic yield. The novel augmented fluoroscopy platform (LungVision, Body Vision Medical Ltd, Israel) integrates existing imaging devices in the operating space into an intuitive fluoroscopic display, providing greater accuracy, visualization and navigation experience than existing virtual bronchoscopic methods. Appreciating the benefits of this innovative technology, the objective of this study is to determine the patient’s and clinician’s radiation exposure during diagnostic endobronchial procedure guided by augmented fluoroscopy.
Methods:
Patients with pulmonary nodules referred for bronchoscopy were included in the study. CT scans were imported into the LungVision planning software, where physicians identified the target nodules and selected the desired pathways. LungVision system was used for real-time localization of the airways and lesion and for directional guidance during biopsy. Using a flexible bronchoscope, a fluoroscopically visible, steerable catheter was introduced through the working channel. The catheter was guided to the target by following a dynamically adjusting pathway over the fluoroscopy image. When the nodule had been reached, a radial EBUS probe was advanced down the catheter and LungVision system recorded fluoroscopy and radial EBUS images. Finally, tissue samples were taken utilizing augmented flouroscopic images. The radiation time and dose were recorded per each navigation procedure. The patient effective radiation dose was calculated using random sampling computer simulation model. Passive personal film dosimeters were placed on the pulmonologist.
Results: 30 patients were recruited to the study. Average lesion size was 29mm±STD (range 7-70mm). No adverse events were reported. Lesion location was verified successfully by radial EBUS in all (100%) cases. Tissue samples were successfully acquired under augmented fluoroscopic and ultrasonic image guidance and recorded diagnostic yield was 73%. The mean fluoroscopy screening time was 3.3± STD min. A median effective radiation dose of 0.65 ± STD milli-Sieverts (mSv) (range 0.16 -1.7 mSv) was received by Patients. The film dosimeters worn on clinicians’ protective cloth recorded measurable radiation doses. Based on attenuation properties of the protective outfits, it has been estimated that the effective radiation dose per procedure to the staff member was 0.0004 mSv or less.
Conclusion: The novel approach of combined augmented endobronchial fluoroscopic and ultrasonic navigation and guidance is safe, feasible and accurate for real time nodule diagnosis. A notable increase of diagnostic yield was observed. Any concern of patient’s radiation exposure should not preclude the use of augmented fluoroscopy in diagnostic bronchoscopy if clinically indicated.
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