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CONE BEAM CT BRONCHOSCOPY: A PARADIGM SHIFT KRISH BHADRA, MD COMMON SPIRIT NATIONAL LUNG COUNCIL CO-CHAIR GO2 LUNG CANCER FOUNDATION SCIENTIFIC LEADERSHIP BOARD

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  • CONE BEAM CT BRONCHOSCOPY: A PARADIGM SHIFT

    KRISH BHADRA, MDCOMMON SPIRIT NATIONAL LUNG COUNCIL CO-CHAIR

    GO2 LUNG CANCER FOUNDATION SCIENTIFIC

    LEADERSHIP BOARD

  • DISCLOSURES

    Boston ScientificMerit MedicalVeracytePhilips Noah Medical

    Medtronic ILSSiemensBodyVisionIntuitiveBiodesix

  • LUNG NODULE BIOPSIES

    IT’S DIFFICULT

    HARD TO REACH PLACES

    THE LUNG MOVES!

    SMALL TARGETS

  • "You jump in the water, and if you don't have goggles or gear, you can't see the quarter — you're just

    groping around blindly," said Rickman, director of interventional pulmonology at Vanderbilt University

    Medical Center. "Fortunately, there's somebody who's pioneering the way for this type of lung

    biopsy, and he happens to be right here in Chattanooga."

  • Northwestern

    Dr. Gillespie

    Dr. Argento

    Vanderbilt

    Dr. Rickman

    Dr. Maldonado

    Tulane

    Dr. Kheir

    Ohio State

    Dr. Pannu

    Stanford

    Dr. Bedi

    Harvard

    Dr. Panchabhai

    VISITING PROFESSORSBaylor

    Dr. Jiwani

    UCSF Fresno

    Dr. Hegde

    MD Anderson

    Banner

    Dr. Shah

  • IMPORTANCE OF REAL-TIME

    CONFIRMATION

    Limitations of standard fluoroscopy

  • • 75 consecutive patients (retrospective)

    • 93 lesions

    • 15 patients with multiple lesions

    • 10 patients with bilateral lesions

    • Median lesion size: 16.0mm

    • Bronchus sign present in only 39% of cases

    • 49% of lesions visible on standard fluoroscopy

    CONE-BEAM CT WITH AUGMENTED FLUOROSCOPY AND ENB JOURNAL OF BRONCHOLOGY AND INTERVENTIONAL PULMONOLOGY 2018, VOLUME 25, NUMBER 4, 273-281

    Pritchett, et al. Journal of bronchology and interventional pulmonology 2018, Volume 25, number 4, 273-281

  • CONE-BEAM CT WITH AUGMENTED FLUOROSCOPY AND ENB JOURNAL OF BRONCHOLOGY AND INTERVENTIONAL PULMONOLOGY 2018, VOLUME 25, NUMBER 4, 273-281

    Diagnostic Accuracy**

    All lesions 93.5%

  • NAVIGATE Thin Scope/rEBUS CBCT/AF/ENB

    Yield: 73% Yield: 49% Yield: 94%

    20mm31mm

    16mm

    Median Lesion: 20mm Median Lesion: 31mm Median Lesion: 16mm

    MEDIAN LESION SIZE VS. YIELD IN VARIOUS STUDIES

  • ADVANTAGES OF BRONCHOSCOPY OVER CT FNA

    Lower morbidity

    Lower mortality

    Reduced length of stay

    Lower risk of pneumothorax

    Allows for mediastinal staging

  • PAIN POINTS: COST AND RADIATION

  • EFFECTIVE DOSE OF COMMON PROCEDURES

    CTA (PE protocol): 15 mSv

    Nuclear Cardiac Stress Test: 9.4 – 12.8 mSv

    Cardiac EP Study: 15-39 mSv (per hour)

    CT Chest Inspiration/Expiration (i.e. for Veran): 9.5 mSv

    Diagnostic Heart Cath: 9-14 mSv

    Therapeutic Heart Cath: 15 – 25 mSv

  • RADIATION DOSE DURING CBCT-GUIDED ENB

    FOR DIAGNOSIS OF PULMONARY NODULES

  • Sputum

    Cytology

    Traditional

    Bronchoscopy

    EBUS

    Navigation

    CTFNA

    Thoracic

    Surgery

    VATS Lung Bx

    DIAGNOSTIC YIELD

    INVA

    SIV

    EN

    ESS

    DIAGNOSTIC YIELD AND

    INVASIVENESS

    CBCT

    Bronch

  • RESEARCH FOR 2020Papers

    Virtual or reality: Divergence between preprocedural computed tomography scans and lung

    anatomy during guided bronchoscopy

    Accepted for Publication to JTD

    Electromagnetic Navigation Bronchoscopy with advanced fluoroscopy-based localization and

    intraprocedural local registration for the evaluation of peripheral pulmonary

    Submitted to JOBIP

    Systematic Review and Meta-Analysis on Proteomic Testing

    Submitted to Chest

    Active Research Trials

    BodyVision Phase 1 trial

    Pending Research Trials

    Lung Vision multicenter trial

    Pulmera CBCT Imaging Trial

    Lung Navigation Ventilation Protocol

    VERITAS: CT Guided FNA versus Navigational Bronchoscopy Non-inferiority Study