Cios Spin in endobronchial interventionsHow a mobile CBCT system can address your clinical and cost challenges
Is your pulmonology practice changing to meet safety and efficiency demands? If not, you may need to consider how you will handle three immediate challenges:
Accurate targeting of pulmonary lesions
3D visualization of lung cancer nodules, airways and devices with Cios Spin to support lung cancer biopsy interventions
Courtesy of Roberto Casal, MD Anderson
3D imaging is essential for accurate lesion targeting
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Bronchoscopic and percutaneous biopsies are established methods to assess the potential malignancy of suspicious lung lesions. For certain indications bronchoscopic biopsy is preferred. However, low diagnostic yield (~50%) from bronchoscopic biopsy is a reality with standard approaches such as traditional bronchoscopy, fluoroscopic or ultrasound guidance.8,9 However, cone-beam CT tool-in-lesion confirmation by cone-beam CT (CBCT) proves navigation success and may lead to increased diagnostic yield.10,5,6 In one study, tool-in-lesion confirmation was the strongest predictor of biopsy success.9
With intra-procedural 2D and 3D imaging Cios Spin may improve diagnostic yield due to controlled navigation when compared to fluoroscopy.8,10 Cios Spin provides sufficient image quality to visualize airways and certain pulmonary nodules during endobronchial interventions.10
Increasing caseload
Doubling Number of biopsies due to screening5,6,7
Increase in caseload because of lung cancer screening and incidental findings
There is a projected two-fold increase of lung cancer biopsies due to the shift in global patient volume toward stage I/II patients. Following the success of the National Lung Screening Trail (NLST) and the NELSON trial, lung cancer screening programs are considered.7,11,12,13,14 In addition to biopsy procedures, there are a variety of additional needs to be met.
Cios Spin offers technology that can be a true multidisciplinary imaging solution across disciplines, which may help to expand return on investment. The system has the potential to effectively guide endobronchial interventions such as biopsies thanks to its 3D imaging. The initial experience shows that Cios Spin could potentially be useful as another modality to assist with the localization of suspicious pulmonary nodules.10
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Cost effective solutions
Cost-effective solutions
Elective procedures have been postponed because of the pandemic.15 Therefore, many providers are now faced with the pressure to reduce spending.
Cios Spin is a state-of-the-art mobile C-arm that offers 2D fluoroscopy and CBCT in the bronchoscopy suite. The system can be used straight away, without time and costs associated with fixed room installation.
Many pulmonologists have small intervention rooms and little or no access to the hybrid OR, making flexibility important. Cios Spin uses less than 13 square feet (~1.2 m²) of space, making it ideal for procedural rooms of any size. With its compact mobile platform, it can be wheeled from room to room and used independent of hybrid OR scheduling.
Recent studies show combinations of Cios Spin with electromagnetic navigation systems16 and endoluminal robots.
A Case Study
An Introduction to Cone Beam CT in Bronchoscopic Interventions
Learn more about the increased use of cone beam CT imaging during bronchoscopic interventions.
Whilst the primary clinical application has been noted as transbronchial biopsy of peripheral lung lesions, additional applications such as transbronchial tumor ablation and cryobiopsy for interstitial lung disease have been reported.
Bray et al. Global Cancer Statistics 2018;0:1-31.
National Cancer Institute. Cancer stat facts: Lung & bronchus cancer, SEER 18 2010-2016.
National Lung Screening Trial Research Team. N Engl J Med 2011;365:395-409.
Assumed combined population and GDP growth ~5%, The World Bank, World development indicators.
Hohenforst-Schmidt, W., Zarogoulidis, P., Vogl, T., Turner, J. F., Browning, R., Linsmeier, B., . . . Brachmann, J. (2014). Cone Beam Computertomography (CBCT) in Interventional Chest Medicine - High Feasibility for Endobronchial Realtime Navigation. Journal of Cancer, 5(3), 231-241. doi:10.7150/jca.8834
Ng, C. S., Yu, S. C., Lau, R. W., & Yim, A. P. (2015). Hybrid DynaCT-guided electromagnetic navigational bronchoscopic biopsy. European Journal of Cardio-Thoracic Surgery. doi:10.1093/ejcts/ezv405
U.S. National Institute Of Health, National Cancer Institute. SEER Cancer Statistics Review, 1975–2015
Casal, R. F., Sarkiss, M., Jones, A. K., Stewart, J., Tam, A., Grosu, H. B., . . . Eapen, G. A. (2018). Cone beam computed tomography-guided thin/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: A prospective pilot study. Journal of Thoracic Disease, 10(12), 6950-6959. doi:10.21037/jtd.2018.11.21
Park, S. C., Kim, C. J., Han, C. H., & Lee, S. M. (2017). Factors associated with the diagnostic yield of computed tomography-guided transbronchial lung biopsy. Thoracic Cancer, 8(3), 153-158. doi:10.1111/1759-7714.12417
Avasarala, S. K., Machuzak, M. S., & Gildea, T. R. (2020). Multidimensional Precision. Journal of Bronchology & Interventional Pulmonology, 27(2), 153-155. doi:10.1097
Aberle et al. N Engl J Med 2013;369(10):920-931
de Koning et al. NELSON trial. N Engl J Med 2020;382(6):503-513
Kauczor et al. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55: 1900506
U.S. National Institute Of Health, National Cancer Institute. SEER Cancer Statistics Review, 1975–2015
Best et al. Surgery 2020;168:962e967
Kalchiem-Dekel et al. Respirology 2020