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Imaging Technology at PHD Provides Window Into Complex Lung Structures
07/02/2008

DALLAS — Pulmonologists on the medical staff at Presbyterian Hospital of Dallas are the first in the Dallas-Fort Worth area — and among the first in the Texas — to use a new type of bronchoscopy that utilizes global positioning-like technology to generate three-dimensional images of the far reaches of complex lung structures.

The system provides a virtual “roadmap” deep into the lungs, enabling pulmonologists to maneuver a catheter through multiple branches of the bronchial tree to reach, view and biopsy targeted lesions.

This electromagnetic navigational bronchoscopy is expected to help pulmonologists better diagnose lung cancer, pneumonia and various pulmonary infections.

“These peripheral lung lesions are beyond the reach of conventional bronchoscopes,” said Dr. Suneel Kumar, a pulmonologist on the medical staff at Presbyterian Hospital of Dallas. “Up to now, diagnosing the lesions has required invasive procedures that can have serious side effects. This new technology allows us to see safely and clearly into those deep regions of the lungs and diagnose exactly what’s causing the respiratory problem.”

Chest X-rays can show peripheral lesions in the lungs of patients, but only about half of those are accessible by traditional bronchoscopy, which involves inserting a flexible catheter tube down the patient’s throat and into the lungs. These standard bronchoscopes limit how far a pulmonologist can explore the complex system of blood vessels and airways in the lungs and chest cavity.

Up to now, most lesions beyond the reach, or view, of a standard bronchoscopy were further investigated with more invasive procedures that had side effects some patients could not tolerate. The only option in many of these cases was “watchful waiting,” doctors say.

“This new technology allows us to more aggressively investigate the origin of disease in the lungs with less impact on the patient,” said Dr. Howard Mintz, a pulmonologist on the medical staff at Presbyterian Hospital of Dallas. “We’re able to more accurately diagnose the condition of the lung and, in turn, better care for the patient.”

The new system uses a steerable catheter that can also access and biopsy lymph nodes that are near the bronchial tree or trachea.

“This technology has the potential to help us diagnose complex problems of the lungs and thoracic cavity with a relatively simple procedure,” said Dr. Gary Weinstein, chief of critical care medicine at Presbyterian Hospital of Dallas and a pulmonologist on the hospital’s medical staff. “It’s an example of technology truly improving clinical care and reducing impact on the patient.”

After the patient’s lung CT scan is imported into a system computer, physicians can generate a three-dimensional image of the lungs. The physician marks the patient’s anatomical points and targets lesions, seen on previous X-rays, on the virtual images generated by the computer system.

With this roadmap, the physician then plans the path the system’s steerable catheter will navigate. The catheter contains a location sensor at its tip that allows 360 degree maneuverability through the bronchial tree. The system provides physicians with a real-time position of the catheter within the lungs. Endobronchial tools are inserted through the guide catheter and used to collect tissue samples to determine if they’re cancerous or caused by infection or other pulmonary disease.

Early diagnosis and treatment are crucial for improving survival rates in malignant lung disease, Weinstein said. A recent study determined that lung lesions diagnosed early resulted in a survival rate of 88 percent at 10 years. Lung cancer patients diagnosed at Stage III or IV have survival rates around 15 percent at five years, he added.

“As rates of lung disease continue to grow in the United States, the challenge of early and accurate diagnosis and treatment of pulmonary lesions is increasingly critical,” Kumar said. “There’s a big need for a reliable diagnostic tool that’s minimally invasive for patients but still provides quality analysis of tissue deep in the lungs. This system is a major step in that direction.”

The new system also gives pulmonologists the ability to place radiosurgical markers in and around lung tumors to help radiation oncologists better plan and treat patients with radiation. These marker placements provide the potential for better outcomes, with reduced complications, Kumar added.

About Presbyterian Hospital of Dallas
Established in 1966, PHD is the flagship hospital of Presbyterian Healthcare System, a member of the faith-based, nonprofit Texas Health Resources system. US News and World Report ranks PHD, a recognized clinical program leader, providing technologically advanced care to patients, among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. The 866-bed facility has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information about PHD, visit www.texashealth.org/phd.

About Texas Health Resources
Texas Health Resources is one of the largest faith-based, nonprofit health care delivery systems in the United States and the largest in North Texas in terms of patients served. THR’s system of 13 hospitals includes Harris Methodist Hospitals, Arlington Memorial Hospital and Presbyterian Healthcare System, and a medical research organization. THR is a corporate member or partner in six additional hospitals and surgery centers. For more information about Texas Health Resources, visit www.texashealth.org.

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