As the bronchoscope gradually made its way down the patient’s trachea and into their airway, Christoph Hutchinson, MD, director of Bronchoscopy at Pennsylvania Hospital, could see that he was getting close. The patient’s previous CT scan indicated that a small nodule had grown on the lower left lung, but it was in a challenging spot on the edge of the lobe. While most nodules are benign, a bronchoscopy was needed to determine whether this mass had developed due to a problem like lung cancer.
Had Hutchinson and his team worked on this case even a month beforehand, he would have gotten as close as he could while working off the patient’s previous CT scan results, and hoped that a tissue sample he took would be enough to provide clear answers. But this time, they had a new secret weapon on their side.
As Hutchinson neared his target, the OR team carefully swung in the hospital’s cone beam CT (CBCT) and positioned around the patient’s chest. It completed one rotation, and he watched the monitor attentively. There it was! With some extra maneuvering per the guidance of the real-time CBCT scan, he quickly pinpointed the nodule and took a precise biopsy.
The enhanced process using CBCT scanning for lung biopsies improved the patient’s chance of catching a potentially cancerous nodule early, and also represents a “first at the nation’s first” and an exciting milestone for the health system.
“Our first use of the cone beam CT at Pennsylvania Hospital this summer was a momentous occasion for our team and Penn Medicine, but it’s also promising for the future of diagnostic imaging and patient care,” said Frances Strauss, MSN, MBA, MHA, RN, CNOR, NE-BC, clinical director of Perioperative Services.
While CBCT scans have been used in fields including oral surgery, orthopaedic surgery, and interventional radiology for years, they only recently gained traction in pulmonology has. Hutchinson was first exposed to CBCT scans during his fellowship training in 2014 and was eager to integrate it into his work when he started working at PAH last year, though he wasn’t sure when he would gain reliable access to the technology. To his surprise, though, a CBCT machine was already set up in the hybrid operating room on Pennsy’s cardiovascular/thoracic floor. When he realized this, he eagerly began preparing to adapt the technology to better meet the needs of his patient population. With the right equipment and software on hand, an excellent team behind him, and a successful dry run under his belt, he just needed to wait for the right patient. Then, in late June, everything aligned.
During the first procedure, OR nurse manager Neil Layden, BSN, RN, felt like he was watching “kids in a candy store” as three interventional pulmonologists from across the health system — David DiBardino, MD, Andrew R. Haas, MD, PhD, and Kevin Ma, MD — dropped in to observe the new tech in action and learn from Hutchinson and the team, which also included OR nurse manager Joshua Brown, RN. “The cone beam streamlined the process and created an on-the-spot road map for Dr. Hutchinson to follow. It was really cool to play a part in an innovative first that could help a lot of patients down the road,” Layden said.
Indeed, any technique that could positively impact lung patients is crucial given that the American Cancer Society estimates more than 135,000 Americans will die from lung cancer in 2020 — making up nearly a quarter of cancer deaths. Pulmonologists often opt to wait and see whether suspicious nodules grow over time, but the hope is that advanced, non-invasive approaches like taking an interprocedural CBCT scan during a bronchoscopy can speed up the diagnostic process and get patients into the treatment they need sooner.
“By combining the cone beam with bronchoscopy, 2D/3D fusion fluoroscopy, and other techniques, we can more confidently access smaller nodules in hard-to-reach areas. That in turn helps us to diagnose patients earlier. This technology allows us to consider unique treatment options such as ablation or pre-operative novel therapeutic administration,” Hutchinson said. “It’s still early, and there’s still a learning curve to navigate, but as we do more of these procedures, we’ll be able to try different things and see how we can improve our yield and get our biopsy accuracy as close to 100 percent as we can. It’s a game changer.”