Aldo Parodi, MD, Pulmonary Disease Specialist AT Baptist Health Systems talks about the VeranSpin and the difference it makes.
Interview conducted by Ivanhoe Broadcast News in September 2018.
How did you first get involved in this particular technique?
Dr. Parodi: Well, I started going to conferences and I started seeing the new technologies. When you go to these yearly conferences like American Oncologist or Chest Physician, it’s all technology and science oriented and you start seeing what is there every year. I also have experience with navigational systems. Five or seven years ago, I did those procedures with the first generation of these machines that worked better than a regular Bronchoscopy, but not completely right. Anyway, it was a good beginning and they gave me hope for this kind of technology. So when I went to those conferences, I look for them.
I want to ask you a question I think is important. Ideally, technologies like this are brought to the general public when they’re invented, but many doctors will stay in the same box and not reach out. It seems to me like you stay current with technology and you were looking for the next big thing. First of all, is that the truth? And secondly, how excited were you to learn about this?
Dr. Parodi: First of all, it corresponds to my field of expertise. Some other doctors don’t have this field of expertise, so they’ll do something different and apply technology according to their field. But I guess it’s everyone’s responsibility to get updated and keep up with the trends every year and see what you can do in the environment you are in with the resources available.
You said you were involved in the first iterations and I want to backtrack a little bit because this ties in with GPS, which now everybody in America understands. How does it tie in? How does that process work?
Dr. Parodi: This process is similar to the GPS. It’s not exactly because when you park a car you use satellite navigation, you know, it’s global. This is based on the same technology that was created in the military. Now it’s applied to science and entered high in the satellite based system is this electromagnetic sensor that you put on the skin. The electromagnetic sensor in catheter site lays on the bronchoscope so I am seeing what I am doing in real time at all times. I know exactly where I am and it’s definitely helpful and it is our own technology.
One of the things I’ve heard doctors say, like when I get a blood test, is that’s just a snapshot of where you were at that time on that day. The difference in this is you’re seeing it in real time and how critical that difference is.
Dr. Parodi: Oh, this does make a big difference. For example, with the previous system, you get a CAT scan one week, two weeks, or one month before and you do this and it’s only one image that is your inspiration, and it’s not part of the procedure so it’s difficult to get insurance to reimburse. In this case, the CAT scans are part of the procedure so there’s no bill to the patient on top of the procedure. You also do it one hour before the procedure, during inhalation and exhalation, so you can see the variation. If you have a one centimeter lesion where the breathing sometimes moves it two centimeters, you have to know where it is so you can calculate when you’re going to hit it. It’s important to do this on the day of the CAT scan because sometimes those lesions have mucus and they go away. If you have a CAT scan that was two or four weeks before, you might be attempting a biopsy on something that does not exist anymore. From all the cases I’ve done these two months, I cancelled three because the lesion was no longer there.
I’m thinking that the reason this is so valuable is that the lesion continues to grow, but what you’re saying is the lesion is actually mobile.
Dr. Parodi: It’s mobile with the breathing. You breathe and the system tells me how much you move. For example, they move ten millimeters and then I usually biopsy during exhalation because the inhalation lasts one second and the exhalation two seconds so I have more time during exhalation than doing inhalation. So I see exactly what the position is during exhalation and then I target the lesion at that time because I have double time and I’ll be closer to my needle.
You’re talking about double time, but in this case you’re talking about two versus one second.
Dr. Parodi: If you breathe normally you do one second, two seconds and then you have COPD, three second during exhalation. For normal patients without lung disease, it’s one second during inhalation and two seconds during exhalation.
Does it matter where the lesion is whether you catch it during inhalation or exhalation?
Dr. Parodi: We only do it in exhalation. It’s more time to do it, but we certainly have to be fast since we have only two seconds to hit it. And then it’s certainly well thought of.
How different is this type of technology compared to existing technology?
Dr. Parodi: First of all, you have deep track instrument so you can see where you’re at, at all times and in real time. The other one is a blind procedure so of course the differences are noticeable. You still can get a diagnosis with a regular Bronchoscopy, but usually in the range of 40% or less. With this technology, you go somewhere between 60% and 90% depending on the location and the expertise. This technology has different tools and if you have them all and you start adding them, the diagnostic tools will get better.
When you put the electrodes on the patient and you use the equipment, how does it know to go for the particular lesion and not just something else in the lungs?
Dr. Parodi: Because I already saw it in the CAT scan and I know which lesion I’m going after. I plan the procedure, get the CAT scan, and download it in the computer software. That computer software is going to convert the CAT scan images into a 3-D map of the airways and lungs and that’s where I’m going to navigate. Then the system tells me where the airways are and I just follow them. You’re going to see when we look at the images. Then it tells me the distances and the angles, but you have to have enough experience with slight movement to get that bronchoscope there.
Chronologically speaking, how much time lapses between the CAT scan that’s taken and the actual procedure?
Dr. Parodi: An hour. The patient first goes to x-ray and they get the CAT scan. There are two CAT scans taking five to ten minutes. But the whole process with the stretchers, the CAT scan, and downloading the images is like 45 minutes, whereas the CAT scan itself is five to ten minutes. This is better because if you have somebody who has claustrophobia, you don’t really want them in there for an hour. It’s not going to work and this is real quick.
As you are doing this, is this a procedure or surgery?
Dr. Parodi: You can call it a procedure, but it’s not surgery. We don’t open incisions on the skin. We use small instruments and needles, and the scope. That’s why there’s less cost, no hospitalization, less risk, and better outcomes if you go after smaller lesions.
Tell me what happens when you do the scan and you have them during the procedure and you insert the needle. How are you then getting rid of the lesion?
Dr. Parodi: First, we need a diagnosis because the target type lesion is 8 to 30 millimeters. Then, you need a diagnosis before you do treatment because only 34% of those lesions are cancer. The other 2/3 are benign lesions and you have to differentiate because that makes a difference for the patient.
How does the equipment or technology differentiate between the benign or the malignant?
Dr. Parodi: It doesn’t and that’s why you do it. You need tissue to diagnose.
So you take tissue out when you insert it in there?
Dr. Parodi: Yeah, I have a pathologist with me in the OR and it’s called ROS, rapid onsite evaluation. When I get a biopsy, they tell me no diagnosis, not enough tissue, so I do another one. They say, oh, this is this. The advantage of doing that is you don’t prolong the procedure when you get a diagnosis. You stop right there.
You said there’s a double or almost a double percentage of a diagnosis or early detection using this technology. For the patient who has lung cancer, how much do their chances of success increase percentage-wise?
Dr. Parodi: You are going from 40% to 80% or 90% and if you add more tools and technology like radial endobronchial ultrasound, you get to hit 94% or 96% diagnostic view. And this is for smaller lesions. The idea is not to diagnose cancer in late stages. It is best not to miss opportunities and diagnose at stage one or two because the survival is a lot better.
So you’re saying that you could use this on late stage cancer, but it’s really intended for early stage?
Dr. Parodi: Yes, because that’s when you can cure. If you’ve got a late cancer, you only do palliation, chemotherapy, and maybe some other therapies. For a stage four lung cancer, the survival at five years is under 4%.
What if you detect it with this in stage one or two, for example?
Dr. Parodi: You get cured and you’re going to be alive in ten years. If they get resected, that means you don’t have cancer anymore. And then there are the missed opportunities. In a recent study from 2010 to 2015 at Moore House University, they found that 75% of the patients are dying of stage three and four when you cannot know the idea and only 15% in stage one and two. Therefore, the idea is to change that trend and diagnose most of them at stage one or two.
You pointed out the gentleman from Hopkins. How many other hospitals and physicians around the country are using this?
Dr. Parodi: There are 260 hospitals throughout the whole country using this, which is 4.6% of hospitals. There are 5,534 registered hospitals in the United States.
Does insurance cover this?
Dr. Parodi: Oh, yeah. This is a recommendation from the American Chest Physician. This was back in 2011 when we started doing low dosage scans. The New England Journal did a study and they found that with early detection, like using CAT scans to find a small lesion, there’s a 20% reduction in mortality from lung cancer.
If you’re a patient and you have lung cancer, what would you tell the people watching this story to ask for in terms of this?
Dr. Parodi: Ask their physician to do a low dosage if they are between 54 and 77 years old and they have been smoking for 30 years or more. That is a high risk population and all the insurance pays for that. It’s a government mandate based on those studies from the National Lung Screening back in 2011.
So if the patient doesn’t fit within that age category or has not been a smoker, what would happen for them?
Dr. Parodi: They would do just plain x-ray. This is the population that has found decreased mortality, at least with the risk of getting cancer. When the patient comes with a small lesion here at low dosage, we do a prediction model based on age, gender, history of cancer, history of location of the lesion, size of the lesion, and form. Then we say this is low risk, intermediate risk or high risk and if it’s in the medium to high risk, we go and try to do something about it. But if it’s less than 5% risk, we just follow it on the CAT scan for another time.
So the last question I have is about this particular patient that we’re going to interview after this. Can you relate to us about his case and how the whole thing happened?
Dr. Parodi: This is a 73 year old man that has smoked for more than 30 years, so he’s in that age group between 54 and 77. He already had a 2.7 centimeter lesion diagnosed in the lungs in 2015 and he underwent a regular Bronchoscopy as un-diagnosis. Then we did the low dose CT, a screening for elderly cancer detection and found that the lesion grew from 2.7 to 3 centimeters. He’s still in the range and his cancer probability risk based on the prediction model was almost 50%. So I said, it’s time to do something about it. We got this system and thoracic navigation and we got it to the operating room, did a procedure, and we got a diagnosis. His diagnosis was carcinoid and now he has an appointment with his oncologist to talk about stage and treatment. I already know he’s at localized disease because we did a PET scan that was negative, although carcinoid usually is PET scan negative. But it is reassuring to have a PET scan that is negative because there is a possibility that it’s a localized disease and he has enough lung capacity and a good cardiac function to undergo surgery.
So if there wasn’t this technology and you had not intervened, what might have been the outcome?
Dr. Parodi: The different outcome is this is going to spread. Cancers don’t stay quite there. They produce and they produce quickly. And when they produce, there is a point in time that you cannot cure people. You only can try to make them feel better, you know? But the target here and the goal is early detection to improve survival and outcomes.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Natalie Gutierrez, PR, Baptist Health System
210-297-1028
Natalie.Gutierrez@baptisthealthsystem.com
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