According to data released by the National Cancer Center (NCC) on the global burden of cancer, lung cancer tops the list for both new cases and deaths. Since the U.S. Preventive Medicine Task Force first recommended lung cancer screening in 2013, the diagnosis rate of advanced lung cancer has declined rapidly, by an average of 6.2% per year, which shows the importance of early lung cancer screening. Lung puncture biopsy is the key to diagnose the nature of lung nodules or masses (occupations), which is mainly performed under the guidance of CT, MR, B ultrasound and other imaging equipment. In recent years, intraoperative 3D C-arm has been gradually applied to the clinic. Compared with traditional CT, intraoperative 3D C-arm has the advantages of fast scanning, real-time guidance, and 3D reconstruction.
Intraoperative 3D C-arm for respiratory intervention
Image-guided diagnosis of pulmonary nodules
Image guidance:
Intraoperative 3D C-arm, spiral CT, radial endobronchial ultrasound, etc.
Main diagnostic modalities:
- Percutaneous puncture biopsy
Puncture biopsy is an important means of obtaining lung nodules, and traditional CT-guided puncture biopsy has a diagnostic rate of more than 90% for puncture biopsy of nodules with a diameter greater than 30 mm, but more than between 70% and 80% for nodules with a diameter of less than 10 mm. Puncture biopsy is an invasive procedure with a high complication rate, with pneumothorax occurring in 13-19% and pulmonary hemorrhage in 18-22%.
- Transbronchoscopic biopsy
Bronchoscopy, especially flexible bronchoscopy, is the main tool for airway examination, diagnosis of airway lesions, therapeutic airway secretion aspiration, and transbronchial puncture biopsy for diagnosis of substantial lung disease. The diagnostic yield of conventional bronchoscopy is low (approximately 70%) and has been shown to improve to 86-94% by combining CBCT and various advanced fluoroscopy systems. Transbronchoscopy is safer and has fewer associated complications, with a much lower incidence of pneumothorax and airway bleeding than percutaneous puncture biopsy.
Advantages of intraoperative 3D C-arm guided lung nodule biopsy
Perlove’s intraoperative 3D C-arm uses cone-beam X-ray scanning instead of 2D X-ray scanning of body CT, and the reconstructed image is directly obtained in 3D.
Mobility and Flexibility Breakthrough the limitations of coordinated use of the CT room
Routine percutaneous biopsy procedures are performed under CT guidance, which belongs to the radiology department. The CT room has to deal with a large number of patients on a daily basis, and the respiratory department has to make appointments and queue up in advance for the use of CT. In addition, patients in the CT room to carry out respiratory interventional procedures, respiratory surgery team needs to overcome the interdepartmental supplies and personnel scheduling, the procedure is relatively complex, low treatment efficiency. Perlove’s intraoperative 3D C-arm is designed to be mobile, and together with other equipment in the operating room/endoscopy room, it can assist in completing one-stop intraoperative positioning+diagnosis+verification.
Intraoperative 3D C-arm is mobile and flexible
Real-time intraoperative imaging Reduces CTBD deviation
A phenomenon known as CT-to-body deviation (CTBD) occurs when the lung volumes from the preoperative CT scan (at full inspiration, breath-hold, and close to total lung capacity) differ from the patient’s lung volumes at the time of surgery (under general anesthesia with mechanical ventilation, with volumes close to functional residual air volume). In addition to differences in lung volumes, the development of pulmonary atelectasis during surgery related to ventilation strategy, oxygen supplementation, and manipulation of the airway with tools may lead to further worsening of CTBD. Such deviations are particularly prevalent for lower lobe nodules during general anesthesia. Intraoperative 3D C-arms can provide real-time image guidance for the procedure, clarifying the relationship of the tools to the lesion and thus improving the positive detection rate of lung nodules.
Three-dimensional Imaging: Seeing the Whole Picture
In two-dimensional images, the biopsy forceps may overlap with the lesion, making it impossible to accurately guide the forceps to the target location. However, intraoperative 3D C-arm can provide cross-sectional, coronal, sagittal, 3D reconstruction images and CT-like tomography images, which can help doctors accurately determine the relationship between the biopsy forceps and the lesion location, thus greatly improving the diagnosis rate.
In addition, small nodules, hair glass opaque nodules, nodules hidden by bony structures or close to some tissue structures (e.g., mediastinum and diaphragm) are usually invisible under 2D fluoroscopy. Intraoperative 3D C-arm imaging can help the surgeon to detect and guide the bronchoscope and biopsy forceps in real time to reach the target location, thus improving the efficiency of biopsy.
Lower radiation dose compared to CT-guided procedures
A spiral CT-guided percutaneous biopsy procedure usually requires about five shots, which results in a higher dose of radiation to the patient and healthcare provider. In contrast, the average single-shot radiation dose for 3D C-arm-guided surgery is about 1/3 of that of spiral CT, i.e., with intraoperative 3D C-arm guidance, the average radiation dose per surgery is about 1.5 shots of spiral CT.
Perlove continues to improve the 3D imaging technology and operational performance of its equipment, and is committed to providing more accurate, convenient and safe products and services for the clinic, and bringing revolutionary diagnostic and therapeutic means to the field of respiratory intervention. Perlove’s intraoperative 3D C-arm will help more and more respiratory specialists in the early diagnosis and treatment of lung tumors!
