Interventional Pulmonology

Interventional Pulmonology is a new field within pulmonary medicine that focuses on multi-disciplinary approach to patient care and the use of advanced diagnostic and therapeutic techniques to treat patients with lung cancer, benign airway disorders and pleural disease. An interventional pulmonologist collaborates with doctors practicing in other medical fields, such as medical and radiation oncology, thoracic surgery on techniques and procedures that will benefit many types of patients. CHI Memorial is the only center in Chattanooga and one of a few centers in the US to offer full complement of advanced diagnostic and therapeutic airway and pleural personalized options for patients.

Krish Bhadra, M.D., interventional pulmonologist, is one of the world’s first pulmonologists using Cone Beam CT (CBCT) bronchoscopy, an advanced technology that is enhancing diagnostic yield of biopsies of difficult peripheral lung lesions. It’s the most advanced form of diagnostic bronchoscopy available today.

Only a few interventional pulmonologists in the country haveaccess to the type of technology that’s readily available in CHI Memorial’shybrid operating room – it’s an option for the pulmonary world that’s trulyunique. CBCT bronchoscopy overcomes some of the challenges with traditionalbronchoscopy that can lead to a non-diagnostic biopsy result. This technologyputs us into a new era of extremely precise biopsies that achieve a higherdiagnostic yield.

With existing electromagnetic navigational bronchoscopy,physicians must work in a virtual platform that makes it more challenging totarget lesions deep in the lung. Cone beam CT provides real-time 3D imagingthat confirms that the diagnostic tool is in the proper location in relation tothe lesion. When it’s on target, the procedure progresses. If it’s slightly offtarget, the low dose 3D CT scan provides information that allows forre-navigation and a greater level of confidence that the biopsy is coming fromthe center of the lesion itself.

CBCT bronchoscopy uses the existing navigationalbronchoscopy and layers in the 3D CT technology to drive toward the targetlesions, leading to a higher level of accuracy while lowering the possibilityfor non-diagnostic bronchoscopies and repeat procedures. CBCT bronchoscopy willbe useful for many people with peripheral lung lesions or nodules and nearlyall are candidates if they can tolerate general anesthesia. The technology hasa very low risk profile and is one of the safest modalities among options forlung biopsies.

A recent meta-analysis of studies on all guidedbronchoscopies resulted in a 70 percent diagnostic yield. In the 31 patientswhere Dr. Bhadra has used CBCT bronchoscopy, “tool-in-lesion” confirmation was97 percent and the diagnostic yield rate was 91 percent. According to Dr.Bhadra, CBCT bronchoscopy has the potential to radically change the nature oflung cancer diagnosis and the ability to target smaller and moredifficult-to-reach lesions for analysis and treatment. Innovative diagnostic toolslike CBCT bronchoscopy are aiding in early detection of lung cancer – leadingto improved treatment outcomes and survival rates.

Endobronchial Ultrasound (EBUS)
EBUS is a technique wherein the pulmonologist uses a special bronchoscope with an ultrasound attachment at the tip of the scope to perform biopsies in multiple areas. This technique minimizes the risk of puncturing a blood vessel and allows for better accuracy, because the interventional pulmonologist can see the needle as it is placed inside the abnormality.

Peripheral Probe Ultrasound (pEBUS)
The peripheral probe is a small probe with a rotating ultrasound tip that allows visualization of peripheral lung nodules. The peripheral probe EBUS can be passed through a bronchoscope and visual peripheral lung lesions alone or in conjunction with GPS navigational bronchoscopy and fluoroscopy (real time x-ray guidance).

Medical Thoracoscopy
Medical Thoracoscopy is a minimally invasive procedure used to evaluate the lung pleura. The pleura is a large sheet of tissue that lines your lung and the inside of your chest wall.  Thoracoscopy is useful to diagnose the cause of the pleural fluid accumulation or thickening. In some cases, we can also apply medication to prevent further fluid from returning.