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The Importance of Tracking Respiration During Navigation

Dr. Andrew Lerner

Chief Interventional Pulmonology Fellow

Johns Hopkins University School of Medicine

Baltimore, Maryland

Patient information: 71 y/o, M

Scan Protocol: Veran’s Inspiration/Expiration CT Scan Protocol

Nodule: LLL 8mm

Target Motion: 3.0cm

Biopsy Results: Pulmonary Adenocarcinoma

Instruments used: Always-On Tip Tracked® SPiN Flex® Needle, Forceps & Brush

Treatment Plan: Surgical Resection


“From the planning stage to the procedure, the ease and flow of Veran allowed for a time efficient and conclusive case which greatly enhanced the care of this patient. The software features enabled me to choose and enhance the most accurate route to the relatively small nodule.”

The importance of tracking respiration during navigation case study
Image from Navigated Bronchoscopy

Patient History
The patient was a 78 year-old man, prior heavy smoker, with a history of acute myelogenous leukemia, who presented with a new 8mm left lower lobe nodule. The nodule was incidentally discovered on surveillance imaging, as he was actively awaiting stem cell transplantation. Though the nodule was small, recommendation was made to pursue tissue biopsy prior to transplantation in order to rule out a second primary malignancy. Given the nodule’s size and location, bronchoscopic biopsy was the preferred method.

The morning of the procedure, the vPad® was placed on the patient’s chest and a CT scan was performed using the Veran Inspiration/Expiration CT Scan Protocol. In this plan, it was observed that multiple airways led to the nodule. Utilizing the software’s feature to map out and grow these airways, several pathways were highlighted to guide access to the target.

Navigation accuracy was then verified by touching the main carina and the right secondary carina. Bronchoscopic navigation to the lesion was successful on first attempt. Veran’s respiratory gating feature played a significant role in tracking the 3.0cm nodule movement between inspiration and expiration.1 Monitoring the nodule movement allowed for accurate navigation to the target. The first pass with the Always–On Tip Tracked® 22ga SPiN Flex® needle revealed Adenocarcinoma. The procedure lasted a total of seventeen minutes. Based off the conclusive biopsy results, a treatment plan was developed; the patient underwent successful surgical resection for stage IA non–small cell lung cancer with plans to begin stem cell transplant following recovery.

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  1. Chen, et al. The effect of respiratory motion on pulmonary nodule location during electromagnetic navigation bronchoscopy. Chest. 2015;147(5):1275-1281: May 2015, vol 147, No. 5.