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Robotic arm linac
Published in Jing Cai, Joe Y. Chang, Fang-Fang Yin, Principles and Practice of Image-Guided Radiation Therapy of Lung Cancer, 2017
Jun Yang, Andrew Cardin, Jing Feng, Xing Liang, EnMing Wang
If it is decided that fiducials are necessary to properly track and treat a tumor, treatment management starts with the implantation of fiducial markers. For lung patients, it is important that fiducials be implanted either inside or very close to the targeted tumor. Several different methods of implantation and types of fiducials are available to the physician to perform this task. Typically, an interventional radiologist implants one or more standard cylindrical gold markers percutaneously under image or video guidance. The gold markers are 0.8–1.2 mm in diameter and 3–6 mm in length, and are pre-loaded in 17- or 18-gauge needles. Due to the risk of pneumothorax in lung patients, there are more advanced placement procedures. Bronchoscopic implantation is accurate and has a smaller chance of causing pneumothorax [10,11]. A recent technological advancement in bronchoscopy, called electromagnetic navigation bronchoscopy (ENB), is minimally invasive and used for hard-to-reach locations in the lung. An example is the superDimension™ lung navigation system (Medtronic, Inc., Minneapolis, MN). This technology allows physicians to perform fiducial placements using an electromagnetic guidance system, like a GPS for the small spaces of lung bronchioles. Other types of fiducials such as the VISICOIL™ (Core Oncology, Santa Barbara, CA) and Gold Anchor fiducial are also available for clinical use implanted percutaneously using a thinner needle. Gold Anchor fiducials have a lower chance of migrating after implantation because the fiducial folds and scrunches into a ball shape within the tissue, immobilizing it immediately after placement. This reduced chance of migration has been substantiated by research [12]. The three different types of fiducials discussed here are shown in Figure 9.3.
Interventional pulmonary medicine
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Chrystal Chan, Christopher A. Hergott
The detection of pulmonary nodules has increased in the past decade due to increasing use of high-resolution computed tomography (HRCT) and the introduction of lung cancer screening programs in many parts of the world. With this, there has been exponential growth in technologies to improve access to peripheral pulmonary lesions. A systematic review and meta-analysis of electromagnetic navigation bronchoscopy (ENB) that included 40 studies and 3,342 participants found a pooled sensitivity of 77% however with significant heterogeneity (I2 = 81%).13 Increased sensitivity was seen with higher cancer prevalence, more tissue sampling techniques, and when the sensor tip was closer to the center of the nodule. Risk of pneumothorax was 2.0%. The superDimension™ platform (Medtronic, Minneapolis, MN, USA) was used in 38 (95%) studies and applicability to other systems may therefore be limited. Vakil and Tremblay appropriately point out in their editorial the lack of robust randomized trials in this field perhaps making these findings less compelling.14
Novel use of electromagnetic navigation for thoracostomy tube placement
Published in Baylor University Medical Center Proceedings, 2021
Sarah Jaroudi, David Sotello, Andres Yepes-Hurtado
Electromagnetic navigation technology in the lung, introduced in the 1990s, allows for the creation of virtual three-dimensional bronchial images based on a preprocedural CT chest scan.5 An extended working channel with a sensor at the tip extends from the bronchoscope, allowing access using virtual reality. It has been routinely used for biopsy of lung lesions, fiducial marker placement, pleural dye marking, and lymph node biopsy. It has even been reported in one case to localize and remove a foreign body.6 The guidelines of the American College of Chest Physicians recommend electromagnetic navigation bronchoscopy with a 1C recommendation grade for peripheral lung lesions that are difficult to access with traditional bronchoscopy.7
Robotic bronchoscopy: potential in diagnosing and treating lung cancer
Published in Expert Review of Respiratory Medicine, 2023
Jennifer D. Duke, Janani Reisenauer
In 2012, Wang et al. performed a meta-analysis of 39 studies evaluating the diagnostic yield of ENB, VB, R-EBUS, ultrathin bronchoscope, and/or guide sheath for peripheral nodules [14]. In 3,052 lesions, the pooled diagnostic yield was 70%, which increased as the size of the lesion increased. The pneumothorax rate was 1.5% [14]. A meta-analysis by Folch et al. recently evaluated the sensitivity and safety of electromagnetic navigation bronchoscopy compared to surgery or longitudinal follow-up. Results showed a pooled sensitivity of 77% and a specificity of 100% for malignancy (40 studies, 3,342 participants) [19].