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Lung Cancer

Integrated image-guided robotic bronchoscopy

More efficiency. More precision. Ready for robotics.

When suspicious lung lesions are identified through screening[1], they often need to be assessed through bronchoscopic biopsy.[2] However, endobronchial navigation is challenging. CT-to-body divergence can reduce targeting precision and may cause complications.[3] The lack of connectivity between supporting technologies hinders efficient workflows.

Siemens Healthineers and Intuitive have teamed up to provide a powerful solution to tackle these challenges. By connecting the Cios Spin mobile C-arm with Intuitive's Ion robotic bronchoscopy system1,2 via the NaviLink 3D interface, we have created an integrated solution designed to increase efficiency and precision in image-guided robotic bronchoscopy.

Image-guided robotic bronchoscopy

Image-guided robotic bronchoscopy with Cios Spin mobile C-arm and Ion

This solution for robotic bronchoscopy is designed to enable you to:

• Work more efficiently with the integrated image transfer between Cios Spin and Ion for a convenient, cohesive workflow from navigation to sampling.
• Gain more precision in the localisation of lesions3 by acquiring Retina 3D cone-beam CT (CBCT)4 images right before biopsy.
• Be ready for robotics with the NaviLink 3D interface that pushes CBCT images to the Ion platform and enables the physician to update the target location in the final stages of the navigation.

Image-guided robotic lung biopsy workflow

When you perform a cone-beam CT during a procedure, NaviLink 3D automatically pushes the 3D image from Cios Spin to Ion. Ion enables the update of the actual lesion location.

    Features & Benefits

    The combination of the Cios Spin mobile C-arm and Ion offers dedicated features for image-guided robotic bronchoscopy.

    Robotic-assisted bronchoscopy with mobile C-arm machine Cios Spin and Intuitive Ion

    Possible setup of operating room during robotic lung biopsy (image courtesy of Intuitive)

    Work more efficiently

    Cios Spin and Ion have been equipped for a plug-and-play connection through NaviLink3D for automated DICOM data transfer between the devices. This removes the need for time-consuming, manual transfer of DICOM data – and creates a convenient, cohesive workflow from navigation to tissue sampling.

    • Combination is in operation at leading lung cancer centers[5,6]
    • Tested and approved compatibility
    • Early case series have shown the benefits of this combination[5,6]

    Cone-beam CT with mobile C-arm Cios Spin

    Gain more precision

    Intraprocedural CBCT imaging with Cios Spin allows you to visualize certain3 pulmonary lesions as you work and identify if the actual location of the lesion deviates from the preprocedural scan.[4] It is now possible to use intraprocedural CBCT data to automatically update the navigation target for more precision in tissue biopsy.

    • True CBCT (Retina 3D) with 16 x 16 x 16 cm3 scan volume
    • Wide-space C-arm with over 93 cm of free space to include peripheral lesions in the 3D volume
    • Up to 25 kW power for high-quality imaging in large patients (optional)

    Watch the integrated workflow: Ion Endoluminal System and Cios Spin cone-beam CT imaging

    Be ready for robotics

    Peripheral lung navigation can be challenging. Ion supports endobronchial navigation while Cios Spin supports tool-in-lesion confirmation. NaviLink 3D enables to integrate with navigation platforms. It is designed for more efficiency and precision in bronchoscopy procedures.

    • NaviLink 3D enables direct and automated DICOM transfer

    Clinical evidence and customer statements

    Single-center studies with small case series have evaluated the impact of using Cios Spin in combination with Ion without the NaviLink 3D interface or as a stand-alone solution.

    Tool-lesion relationship during robotic-assisted bronchoscopy  

    Optimization of needle deployments

    In publication [5] the authors noted: “[The] initial needle deployment [before the first correction] into the target as defined by 3D fluoroscopy spin was successful in 8 of 10 lesions. 3D fluoroscopy [Cios Spin]-guided repositioning of the robotic catheter [Ion] allowed optimization of three needle deployments; two from off-center to center and one from miss to off-center.” 

    Diagram showing accurate placement of biopsy tool during robotic lung biopsy

    CT-to-body divergence during image-guided robotic bronchoscopy (diagram adapted from [3])

    Accurate placement of the biopsy tool

    In abstract [6] (with data from [3]) the authors noted: “Shape sensing robotic technology [Ion] combined with mobile CT imaging [Cios Spin] allows for accurate placement of the biopsy tool in the lesion. This combination may enhance diagnostic ability for sampling of peripheral pulmonary nodules and translate well in the applications of therapeutics in the future. Mobile 3D imaging allows for flexibility and maneuverability without the need for an expensive, fixed CBCT room with adequate image quality.”

    Robotic lung biopsy with mobile C-arm machine Cios Spin and Intuitive Ion

    Bronchoscope in the airway (solid arrow) and biopsy tool (dashed arrow) within a nodule during image-guided biopsy (image from [4])

    High tool-in-lesion rate

    In publication [4] the authors noted regarding the final navigation result: “From this initial experience, the technology [Cios Spin] could potentially be useful as another tool to assist with the localization of suspicious pulmonary nodules. We believe the 100% rate of ‘tool-in-lesion’ is beneficial.”

    Webinars and Customer Talks

    Hear what our customers are saying 

    Dr. Hohenforst-Schmidt, MD

    Dr. Folch, MD

    Dr. Takizawa, MD

    Dr. Herth, MD

    Mobile or stationary cone-beam CT in interventional pulmonology? - A multisite experience

    Wolfgang Hohenforst-Schmidt, MD, Bamberg Clinics Lung Center, Germany

    Image-guided robotic bronchoscopy - Adding the missing piece

    Erik Folch, MD, Complex Chest Disease Center, Massachusetts General Hospital, Boston, USA

    Mobile cone-beam CT to guide endobronchial interventions – A cost-efficient but powerful option

    Hiromitsu Takizawa, MD, Department of Thoracic, Endocrine Surgery and Oncology, University of Tokushima, Japan

    The role of pulmonology in lung cancer screening 

    Felix Herth, MD. University of Heidelberg, Germany

    A European Commission plan aims to improve early cancer detection and treatment. Heidelberg is a hub for cancer research and treatment, and it is It is the largest lung clinic in Europe. Pulmonology plays a pivotal role to companion patients on their journey and it is an important voice in multi-disciplinary tumor boards. What can we expect from lung cancer screening in Europe and which implications will have screening on therapy and interventions?, are questions addressed in this presentation. 


    References

    [1] US Preventive Services Task Force, Krist AH et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021; 325(10):962-970

    [2] Shen YC et al. Advances in Diagnostic Bronchoscopy. Diagnostics (Basel). 2021; 11(11):1984

    [3] Reisenauer J et al. Combining Shape-Sensing Robotic Bronchoscopy with Mobile Three-Dimensional Imaging to Verify Tool-in-Lesion and Overcome Divergence: A Pilot Study. Mayo Clin Proc Inn Qual Out. 2022; 6(3):177-185

    [4] Avasarala SK et al. Multidimensional Precision: Hybrid Mobile 2D/3D C-Arm Assisted Biopsy of Peripheral Lung Nodules. J Bronchology Interv Pulmonol. 2021; 27(2):153–155

    [5] Kalchiem-Dekel O et al. Multiplanar 3D Fluoroscopy redefines tool-lesion relationship during robotic assisted bronchoscopy. Respirology. 2021; 26(1):120–123.

    [6] Reisenauer J et al. The combination of shape sensing robotic bronchoscopy with mobile 3D imaging to verify tool-in-lesion and assess divergence. Chest. 2021; 160(4):2529

    1

    The information shown herein refers to a product of 3rd party manufacturer Intuitive and thus are in their regulatory responsibility. Please contact the 3rd party manufacturer for further information and availability.

    2

    Intuitive Ion Endoluminal System with the Siemens Healthineers NaviLink 3D interface is 510(k) cleared. Currently, it is not for sale outside the U.S. Its future availability cannot be guaranteed.

    3

    In study [4] the mean lesion size was 2.6 cm x 2.4 cm. In study [5] the median lesion size was 1.45 cm (range: 0.73–7.74 cm) and 9 of 10 lesions were radiographically solid.

    4

    Cone beam CT (Siemens Healthineers brand name Retina 3D) is a method to acquire volumetric (3D) images by rotation of a C-arm around an object. 2D X-ray images are taken at equidistant angles and reconstructed to a volume.

    The statements by Siemens Healthineers’ customers described herein are based on results that were achieved in the customer's unique setting. Because there is no “typical” hospital or laboratory and many variables exist (e.g., hospital size, samples mix, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results.

    The Intuitive logo is trademark of Intuitive Surgical.

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