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Collaboration with Interventional Radiology Results in Safer, More Accurate Lung Biopsies

Pulmonologist Christopher Towe, MD, is able to obtain more accurate biopsies of lung lesions more efficiently, thanks to a new collaboration with interventional radiologist John Racadio, MD.

The two have developed an approach to critically important lung biopsies that eliminates the guesswork of obtaining tissue samples from deep-seated lesions. The collaboration is possible because of Cincinnati Children’s Hybrid OR, a suite that houses advanced imaging technology within the operating room. Interventional radiologists work alongside surgeons and proceduralists, providing them with real-time images that give the team unprecedented views and information as procedures are performed.

As a pediatric pulmonologist who specializes in treating children with rare lung diseases, Towe frequently performs biopsies of lung tissue using flexible bronchoscopy. The method, while less invasive than others used for biopsies, has its limitations. 

“Often we are looking at lesions deep within the lungs. The forceps are smaller than the bronchoscope and can reach into areas of the lung where the bronchoscope can’t see,” he explains. “Historically, these biopsies were considered ‘blinded’ - you didn’t know exactly where the forceps was going. We couldn’t biopsy predictably and effectively because we couldn’t see exactly where the forceps was ‘biting.’”

But Racadio, Director of Interventional Radiology Research and Innovation in the Department of Radiology and Medical Imaging, helped Towe overcome this hurdle. As Towe guides the instruments during the biopsy, Racadio uses a C-arm cone beam CT to identify the lesion to be biopsied, then maps the area in three dimensions. The 3D image of the lesion is fused with an existing X-ray image, giving Towe a three-dimensional view. A guide catheter can then be advanced through the bronchoscope and positioned more distally into the correct sub-segmental bronchus. The forceps can then be advanced repeatedly through the catheter for multiple biopsies.  Additionally, the system’s software helps Towe navigate around the lesion to accurately position the forceps. “It allows me to see in three-dimensional space precisely where the forceps is going” says Towe.

Beyond the technology, Racadio says, what makes the joint effort work so well is the willingness of the doctors to share their knowledge and learn from one another. “The technology is cutting edge, but the procedure could not be performed without collaboration between Pulmonology and Interventional Radiology,” he says. “We leverage the skills, expertise, and technologies of two disciplines to create a better way of performing transbronchial biopsies in children. What I have found in the two years since our Hybrid OR has opened is that, in general, surgeons and interventional bronchoscopists don’t know all that is possible with image guidance, and interventional radiologists don’t understand all of the needs of surgeons and interventional bronchoscopists. By communicating and collaborating, we are overcoming these gaps in understanding.”

Prior to this collaboration, children with lesions deep within the lung often had to undergo more extensive needle or surgical biopsies, says Towe. Using the Hybrid OR minimizes the time patients are anesthetized; the lung biopsy procedure can be performed on an outpatient basis, with most patients able to return home the same day.

“To our knowledge, this approach has not been used for this purpose before, especially in children,” says Towe. “We are one of the few children’s hospitals with a Hybrid OR and such a strong interventional radiology team. Our pulmonologists are highly skilled in using flexible bronchoscopy. This new collaboration is a tremendous synergy that will truly benefit our patients.”

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