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ORIGINAL RESEARCHINTERVENTIONAL PULMONOLOGYElectromagnetic Navigation Bronchoscopy-Guided Fiducial Placement for Robotic Stereotactic Radiosurgery of Lung Tumors: A Feasibility Study
Section snippets
Materials and Methods
Nine consecutive patients who were referred for bronchoscopic fiducial placement were recruited between September 2005 and April 2006. All patients had peripheral lung tumors and no CT evidence of endobronchial pathology. The cases were reviewed at a multidisciplinary thoracic oncology clinic, and seven were deemed inoperable. Two additional patients declined surgery when informed of the potential surgical risks and complications due to their medical comorbidities. The indications for all nine
Results
Thirty-nine fiducial markers were placed in nine patients. Mean age of these patients was 69 ± 13 years (range, 46 to 92 years). Histology, size, and stage of the tumors are listed in Table 1. Majority of these patients had multiple comorbidities and poor pulmonary function. Mean FEV1 was 39 ± 10% of predicted.
During ENB, the mean number of registration points used was 6 ± 1 (range, 5 to 7). Mean registration error was 6.1 ± 0.2 (range, 5.9 to 6.5 mm), while the documented navigation error was
Discussion
Cyberknife radiosurgery has emerged as an alternative for patients with lung cancers who are inoperable for medical reasons.11 Bronchoscopic fiducial placement in the thorax is more attractive than either transthoracic or intravascular deployment because of the improved side effects profile. Transthoracic fiducial placement has a reported pneumothorax rate of 13%.11 This percentage may not be representative of the actual incidence because the pneumothorax rate for transthoracic CT-guided
ACKNOWLEDGMENT
Arthur Dea and Robert Garland from Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, assisted with manuscript editing and data collection.
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The locatable sensor probes for electromagnetic navigation bronchoscopy were provided free of charge by superDimension. superDimension has supported continuing medical education courses at Harvard University through unrestricted educational grants. Dr. Ernst was a member of the Scientific Advisory Board of superDimension and has been reimbursed for time and travel expenses related to that function. Dr. Ernst also had stock options in superDimension, which have been returned in the past. Dr. DeCamp is a member of the Scientific Advisory Board of superDimension and Accuray and has been reimbursed for time and travel expenses related to that function. Neither Dr. Ernst nor Dr. DeCamp were involved in the consenting process. Drs. Anantham, Feller-Kopman, Shanmugham, Berman, Gangadharan, Eberhardt, and Herth have no conflict of interest to report.
A portion of this data was presented as an abstract at the European Respiratory Society Congress, Munich, Germany, 2006.