The ION robot is a unique
tool for MedStar Georgetown University Hospital.
We were one of the first sites in the United States to have
this commercially available to us for a better chance
of getting a diagnosis of a peripheral lung nodule.
The ION robot is a fancy bronchoscopy
where the robot is placed to push the scope through the airway.
The bronchoscopist will guide the bronchoscope
through the airway using a mouse pad with a trackball on it.
Much like the video games you used in the past.
Here we're using it for medical purposes
to make a more accurate pathway to get to the target in the lung.
Lung nodules can show up anywhere in the lungs, and it's challenging
sometimes to get close to the nodules through the airways.
The ION robot provides several advances
that allow us to more accurately biopsy spots in the lung.
The first advance is that the technology involves
a computer recreation of the airways
that allows us to plan ahead of time
which pathway we're going to go down to get to the target.
The second advantage is that this machine will allow us
to get very close to the target and point directly at the target.
Of course, the benefit of doing a bronchoscopy biopsy over a
CT-guided biopsy is there's less complications.
The third part of bronchoscopy with the ion robot that makes it unique
is the ability to stay fixed and firm, but yet flexible.
We can turn it through the different airways,
and once we've got it facing the target, we can lock it into position, allowing us
to do multiple biopsies through different techniques to get to our target.
The first step of ION robot is to get a CT
scan done at our hospital with very fine resolution cuts,
that CT scan is put into our
planning software, and we can create with the technology
from the computer a pathway towards the target.
Once we've chosen the correct target,
we take that information and put it into the robot.
During the bronchoscopy,
the ION robot is connected to the endotracheal tube
that the anesthesiologist has placed for general anesthesia.
We put our cameras down through that endotracheal tube into the airway,
and, using the robot, we guide the catheter out to the peripheral nodule.
Once we get there, we can lock this
catheter in position,
aim directly at the target,
and we can place our needles and our biopsy tools
through the robot directly at the target that we're going for.
The ION robot is more accurate than conventional bronchoscopes.
In the past, the chance of us biopsying a small target
in the periphery of the lung was less than 15 or 20 percent.
And now we move that chance
of getting a diagnosis on a small nodule in the lung
up to 80 percent or more.
The ION robot has multiple ways
of giving us feedback of where the target is.
The display tells us exactly how many millimeters
we are away from the target, from the front edge
of the target to the back edge of the target and to the plural
surface, the lining of the lung
beyond that, allowing us to more safely biopsy directly through the target
in a measured distance and not worry about going too far to hit the plural surface.
It also gives us feedback on which direction we're aiming
and, using this with a radio ultrasound,
we can confirm that
we're right up against the nodule before we start taking those biopsies.
A common question to us is whether the robot is autonomous
and doing this procedure by itself, and the answer to that is no.
The interventional pulmonologist is driving the robot through the airways.
We're using the feedback from the many displays that we have
to figure out which airway to turn each
branch of the airway as we go out to the targets in the periphery.
The robot is a tool that is guided by the interventional pulmonologist.
It does not work by itself.
In the past, getting a diagnosis of a lung nodule
to see if it's lung cancer or not was challenging, it may have required more
than one biopsy, a biopsy from the outside using C.T. guidance,
perhaps a biopsy also from the inside.
Sometimes we even needed surgery to figure out what a small lung nodule is.
The iron robot has allowed us to have a technology
that allows us to get to the periphery and get to these smaller nodules
with a much better chance of getting a diagnosis the first time.
Our hope is that the use of ION robotic
bronchoscopy is going to allow us to detect early stage lung cancers,
lung cancers that may be curable at these earliest stages.
In the past, we may not
have even been able to go try to biopsies because they're too small.
Now we have the possibility of more accurately biopsy nodules
that are less than two centimeters,. and in almost a third of our patients,
we have gone after nodules that are less than one centimeter.
This is the game changer that we've been waiting for,
the ability to biopsy spots that are less than one centimeter.
If we can diagnose a spot that's one centimeter
and send them to surgery, they have a chance of cure of 90 percent.
We need to have more patients show up earlier detection with lung cancer
screening and use technologies such as the iron robot
to biopsy this peripheral nodule to get a diagnosis
when it matters, when it's small, before it has spread to somewhere else.
So, the other possible uses of the iron robot are placing
fiduciary markers in preparation for radiosurgery with CyberKnife.
We've already placed a third of our patients who've undergone robotic
bronchoscopy, had fiducials is inserted.
And we're finding that the accuracy of these markings
are even closer than we were doing before.
Being able to use a robot to get close to the target
and more accurately placed gold markers around the target
means that will be more accurate with treating with the CyberKnife radiation.
Fiducials are gold markers that we use
by the CyberKnife radiation team to track
the target that they're going after with the treatment, with the radiation.
They don't actually treat the patient, but they mark the targets
so that the radiation team can see the target that they're aiming at.
Gold is an interesting metal.
It's inert and it's easy to see on X-rays.
Where the CyberKnife can't see a target very well in the lung
because it may be hidden behind the shadows of the heart or somewhere else,
it can see gold very well.
So, we use gold fiducial markers to tell where the target is
as part of the planning process for radiation treatments with CyberKnife.
The other application for the ION robot may be to mark
small tumors who are in need of resection by the surgeon.
Surgeon often cannot feel small nodules in the lung, and
if we put dye marking around the target, the surgeon will be able
to see the dye when they go to surgery later that day or the next day.
Use of the ION robot for bronchoscopy is going to be
the standard of care for patients who come in with lung nodules.
We know the chance of us getting a diagnosis with the robot
bronchoscopy is much higher than with our conventional bronchoscope
or even with the previous technologies that we use.
This is the new technology here today.