Pulmonologists at Presbyterian Hospital (Dallas) have begun using a new type of bronchoscopy that uses GPS-like technology to generate 3-D images of the far reaches of complex lung structures. This electromagnetic navigational bronchoscopy is expected to help pulmonologists better diagnose lung cancer, pneumonia and various pulmonary infections.

"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," said Presbyterian pulmonologist Suneel Kumar, MD.

The inReach system from privately-held superDimension (Minneapolis) was cleared for marketing in the U.S. last September (Medical Device Daily, Sept. 10, 2007). According to the company, the new imaging tool helps doctors reach smaller, harder-to-reach lung lesions.

Presbyterian has been using the new device since January, Kumar told Medical Device Daily. He says the device is unlike anything else on the market that he is aware of.

"The big benefit is that we can certainly go after lesions that are smaller and even go after them more accurately by being able to plan out the procedure beforehand using the patient's CT scan," Kumar said.

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. Until now, most lesions beyond the reach of a standard bronchoscopy were further investigated with more invasive procedures that had side effects some patients could not tolerate, according to Presbyterian.

"This new technology allows us to more aggressively investigate the origin of disease in the lungs with less impact on the patient," said pulmonologist Howard Mintz, MD. "We're able to more accurately diagnose the condition of the lung and, in turn, better care for the patient."

superDimension says the inReach system provides a 3-D virtual "roadmap" of the lungs that enables a physician to maneuver the inReach catheters through multiple branches of the bronchial tree to reach targeted lesions.

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

According to the company, after a patient's CT scan of the lungs is imported into the inReach planning laptop, a three-phase process occurs: planning, registration and navigation.

During the planning phase, the inReach planning software generates a 3-D image of the patient's lungs, the doctor marks the patient's anatomical points and targets lesions on the virtual and CT images, then uses those images to plan the path that the inReach catheters will follow in the bronchial tree, and the patient's virtual plan is saved and exported to a flash drive.

In the registration phase, the patient's virtual plan is downloaded into the inReach system computer. Then, a conventional bronchoscope is inserted, and the inReach catheters are inserted into the bronchoscope channel. The doctor then uses the location sensor at the navigation catheter's tip to mark the actual anatomy of the patient in the positions marked earlier on the virtual and CT images. This provides a "registration" of the pre-acquired CT scan to the patient's anatomy, the company said.

During the navigation phase, the doctor uses the CT images and steering directions on the inReach monitor to navigate the catheters to target areas in real time. Next, the guide catheter is locked in place and the steerable navigation catheter is removed. Lastly, endobronchial tools are inserted through the guide catheter and used to collect tissue samples.

"This technology has the potential to help us diagnose complex problems of the lungs and thoracic cavity with a relatively simple procedure," said pulmonologist Gary Weinstein, MD, chief of critical-care medicine at Presbyterian. "It's an example of technology truly improving clinical care and reducing impact on the patient."

Early diagnosis and treatment are crucial for improving survival rates in malignant lung disease, according to Presbyterian. The hospital noted a recent study that determined that lung lesions diagnosed early resulted in a survival rate of 88% at 10 years. Lung cancer patients diagnosed at stage III or IV have survival rates around 15% at five years.

"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," Kumar said. "This system is a major step in that direction."