Five years ago, Roswell Park Comprehensive Cancer Center was the first hospital in New York State to offer robotic bronchoscopy to explore and biopsy lesions in a patient’s lung believed to be cancerous. Nathaniel Ivanick, MD, FCCP , Director of the Interventional Pulmonary Service in the department of Thoracic Surgery at Roswell Park.
Galaxy System™ “builds on an electromagnetic system allowing you to triangulate and effectively move out to lesions of the periphery of the lung,” he says. “The CT to body divergence makes biopsies in the body somewhat less accurate unless you can, in real time, adjust the positioning of the bronchoscope in relation to the nodule,” which could be in a position up to 20 millimeters away from where the original scan indicated.
The new system is an estimated three times more accurate in identifying nodules compared to traditional radiology, allowing physicians to see “with much greater precision both small nodules and less dense nodules. It also uses substantially less radiation,” about an 88% reduction in exposure to radiation for both patient and practitioner.
Additionally, the new system reduces the risk of injury to the patient’s lung, which Dr. Ivanick expects will result in fewer pneumothoraces to patients in addition to a reduced risk of bleeding in the lungs following the biopsy.
Hi, my name is Nate Ivanic. I'm an interventional pulmonologist within the department of thoracic Surgery at Roswell Park Comprehensive Cancer Center. I'm here to discuss one of Roswell's latest acquisitions to help us diagnose and fight lung cancer and other cancers in the lungs, and that's called the Galaxy robot. In 2021. Roswell Park became the first hospital in New York State to begin using robotic bronchoscopy to target lesions that were in the periphery of the lung. This was an exciting advancement in that we were able to take our biopsies further out into the periphery with greater accuracy and to be able to target lesions that were previously too small and too peripheral to biopsy. We used that technology for about 5 years. And other technologies have come along in the meantime that represented a chance to achieve greater success in identifying and biopsying peripheral lung nodules. One of those technologies is the Galaxy robotic bronchoscope system. That's what we've purchased now at Roswell that is both innovative and very effective at allowing us to target smaller lesions and hopefully in the very near future to To peripheral therapeutic options in the lung, it builds on an electromagnetic system allowing you to triangulate and effectively move out to the lesions that are in the periphery of the lung. But what we've discovered is that CT to body divergence makes biopsies in the periphery somewhat less accurate unless you can in a real time way adjust the positioning of the bronchoscope in relation to the nodule specifically. The place where the nodule existed at the time that the patient got the CAT scan is often no longer the place where the nodule exists at the time of bronchoscopy. This happens for several reasons. First, passive ventilation, which happens during the time of the CAT scan, means that air is pulled into the chest. All of the muscles are active and working. And the nodule is kind of seen in a position during the patient having a maximum inhalation. Then, during the procedure, the patient receives muscle relaxants and they're undergoing passive ventilation whereby air is being pushed into their airway. All of these things, as well as the bronchoscope being physically within the airway, can actively change the position of the nodule. I myself have seen the position of the nodule change from its planned position by as much as 20 millimeters in its subsequent identification. So this is a real thing that happens and likely accounts for some of the biopsies that we were obtaining that were not positive for cancer, even though our suspicion for it was high. The galaxy robot uses something called digitaltoma synthesis to again reidentify the new position of the nodule, allowing us to change. Our plan and position to get a real-time view of it and take our best biopsies. Digital tomosynthesis uses the power of the traditional CR, which is a technology that has been around for many years. And what it does is rather than shoot in a single plane of front to back X-ray, it actually allows us to slowly rotate the CA around the patient, creating. In effect, a cone beam CT right there in the room without having to use a cone beam CT. The advantages of digital tomosynthesis are first, that it is 3 times more accurate at identifying nodules than traditional radiology, allowing us to see with much greater precision, both smaller nodules and less dense nodules such as ground glass opacities. A second advantage is that digital tomosynthesis uses substantially less radiation, meaning that the patient as well as the providers see a lot less effect. It's estimated that it's about 88% less radiation dosage than what is seen in a traditional CT of the chest. Some of the other benefits of performing robotic bronchoscopy this way include the Reduce risk of injury to the lung as you're taking biopsies. Because we can be more exact in where we need to be, we expect that this will result in fewer pneumothoracis to our patients as well as less risk of bleeding. I think the reason that uh referring physicians should send their patients to Roswell for diagnosis is first because of this robot. I think that greater accuracy is an important Thing for all of us as we want to answer the question of if our patients have cancer, greater safety involved in the procedure is another major benefit. The second reason that providers should send their patients to Roswell is that we're a comprehensive cancer center right down the hall for me in my clinic. I can chat with thoracic surgeons. I can chat with radiation oncologists and medical oncologists so we can really coordinate the care to achieve the best possible outcomes. And we also use a tumor board to discuss patients with complexities beyond the standard just single lung nodule so we can get a really good sense of what the best treatment options are. Finally, clinical trials which are available at Roswell are paving the way toward new. Treatments in lung cancer and other cancers. All of those reasons are important reasons to send patients to Roswell. If you have a patient who you believe may benefit from the Galaxy robotic bronchoscopy or other procedures that we perform, please don't hesitate to reach out to us to learn more.
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