Bronchoscopies

Endobronchial Ultrasound
Navigational Bronchoscopy
Brachytherapy

Diagnostic & Therapeutic Bronchoscopy


Bronchoscopy
is a diagnostic procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy, your doctor will examine your throat, larynx , trachea  and lower airways.

Bronchoscopy may be done to diagnose problems with the airway, the lungs, or with the lymph nodes in the chest, or to treat problems such as an object or growth in the airway.

There are two types of bronchoscopy.
  • Flexible bronchoscopy uses a long, thin, lighted tube to look at your airway. The flexible bronchoscope is used more often than the rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and offers a better view of the smaller airways. It also allows the doctor to remove small samples of tissue (biopsy).
  • Rigid bronchoscopy is usually done with general anesthesia and uses a straight, hollow metal tube. It is used:
            - When there is bleeding in the airway that could block the flexible scope's view.
            - To remove large tissue samples for biopsy.
            - To clear the airway of objects (such as a piece of food) that cannot be removed using a
              flexible bronchoscope.

Special procedures, such as widening (dilating) the airway or destroying a growth using a laser, are usually done with a rigid bronchoscope.

Why It Is Done

Bronchoscopy may be used to:
  • Find the cause of airway problems, such as bleeding, trouble breathing, or a long-term (chronic) cough.
  • Take tissue samples when other tests, such as a chest X-ray or CT scan, show problems with the lung or with lymph nodes in the chest.
  • Diagnose lung diseases by collecting tissue or mucus (sputum) samples for examination.
  • Diagnose and determine the extent of lung cancer.
  • Remove objects blocking the airway.
  • Check and treat growths in the airway .
  • Control bleeding.
  • Treat areas of the airway that have narrowed and are causing problems.
  • Treat cancer of the airway using radioactive materials (brachytherapy).
How It Is Done

You may be asked to remove dentures, eyeglasses or contact lenses, hearing aids, wigs, makeup, and jewelry before the bronchoscopy procedure. You will empty your bladder before the procedure. You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the procedure). You will be given a cloth or paper covering to use during the procedure.

The procedure is done by a pulmonologist and an assistant. Your heart rate, blood pressure, and oxygen level will be checked during the procedure.

A chest X-ray may be done before and after the bronchoscopy.

Flexible bronchoscopy

During this procedure, you will lie on your back on a table with your shoulders and neck supported by a pillow, or you will recline in a chair that resembles a dentist's chair. Sometimes the procedure is done while you are sitting upright.

You will be given a sedative to help you relax. You may have an intravenous line (IV) placed in a vein. You will remain awake but sleepy during the procedure.

Before the procedure, your doctor usually sprays a local anesthetic into your nose and mouth. This numbs your throat and reduces your gag reflex during the procedure. If the bronchoscope is to be inserted through your nose, your doctor may also place an anesthetic ointment in your nose to numb your nasal passages.

Your doctor gently and slowly inserts the thin bronchoscope through your mouth (or nose) and advances it to the vocal cords. Then more anesthetic is sprayed through the bronchoscope to numb the vocal cords. You may be asked to take a deep breath so the scope can pass your vocal cords. It is important to avoid trying to talk while the bronchoscope is in your airway.

An X-ray machine (fluoroscope) may be placed above you to provide a picture that helps your doctor see any devices, such as forceps to collect a biopsy sample, that are being moved into your lung. The bronchoscope is then moved down your larger breathing tubes (bronchi) to examine the lower airways.

If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or brush will be used through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab to be studied.

Finally, small biopsy forceps may be used to remove a sample of lung tissue. This is called a transbronchial biopsy.

Rigid bronchoscopy

This procedure is usually performed under general anesthesia. You will lie on your back on a table with your shoulders and neck supported by a pillow.

You will be given a sedative to help you relax. You will have an intravenous line (IV) placed in a vein. Once you are asleep, your head will be carefully positioned with your neck extended. A tube (endotracheal) will be placed in your windpipe (trachea) and a machine will help you breathe. Your doctor then slowly and gently inserts the bronchoscope through your mouth and into your windpipe.

If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or a brush will be inserted through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab for biopsy.

Recovery after bronchoscopy


Bronchoscopy by either procedure usually takes about 30 to 60 minutes. You will be in recovery for 1 to 3 hours after the procedure. Following the procedure:

Do not eat or drink anything for 1 to 2 hours, until you are able to swallow without choking. After that, you may resume your normal diet, starting with sips of water.
Spit out your saliva until you are able to swallow without choking.
Do not drive for at least 8 hours after the procedure.
Do not smoke for at least 24 hours.

Source: WebMD
http://www.webmd.com/lung/bronchoscopy-16978Endobronchial Ultrasound (EBUS)

Endobronchial Ultrasound (EBUS)

Endobronchial ultrasound (EBUS) is a relatively new procedure used in the diagnosis of lung cancer, infections, and other diseases causing enlarged lymph nodes in the chest.

Why is it used?
  • EBUS allows physicians to perform a technique known as transbronchial needle aspiration (TBNA) to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery. The samples can be used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis or other cancers like lymphoma.
What makes EBUS different?
  • During the conventional diagnostic procedure, surgery known as mediastinoscopy is performed to provide access to the chest. A small incision is made in the neck just above the breastbone or next to the breastbone. Next, a thin scope, called a mediastinoscope, is inserted through the opening to provide access to the lungs and surrounding lymph nodes. Tissue or fluid is then collected via biopsy.
During an endobronchial ultrasound:
  • The physician can perform needle aspiration on lymph nodes using a bronchoscope inserted through the mouth
  • A special endoscope fitted with an ultrasound processor and a fine-gauge aspiration needle is guided through the patient’s trachea
  • No incisions are necessary
Benefits of EBUS
  • Provides real-time imaging of the surface of the airways, blood vessels, lungs, and lymph nodes
  • The improved images allow the physician to easily view difficult-to-reach areas and to access more, and smaller, lymph nodes for biopsy with the aspiration needle than through conventional mediatinoscopy
  • The accuracy and speed of the EBUS procedure lends itself to rapid onsite pathologic evaluation Pathologists in the operating room can process and examine biopsy samples as they are obtained and can request additional samples to be taken immediately if needed
  • EBUS is performed under moderate sedation or general anesthesia
  • Patients recover quickly and can generally go home the same day
Source: UC San Diego Health System
http://health.ucsd.edu/specialties/pulmonary/procedures/Pages/endobronchial.aspx

Navigational Bronchoscopy

What is Navigational Bronchoscopy?

We use navigational bronchoscopy to help doctors to find and reach tumors located in the periphery of the lungs, where smaller bronchi are not wide enough to allow passage of a normal bronchoscope. With navigational bronchoscopy, doctors can find lung tumors, take biopsies and administer treatment.

Navigational bronchoscopy, which combines advanced imaging techniques with electromagnetic navigation, is used to:
  • Find and biopsy suspicious masses
  • Suction excess fluid or mucus from the airway or chest
  • Control bleeding in the airway
  • Treat tumors in the airway using HDR brachytherapy
  • Place airway stents
  • Place catheters in vital areas of the lungs
Navigational bronchoscopy is minimally invasive compared to purcutaneous lung biopsy procedures. It also requires less time for recovery and can be done on an outpatient basis.


Source: Cancer Treatment Centers of America
http://www.cancercenter.com/treatments/navigational-bronchoscopy/

Brachytherapy

Brachytherapy is a procedure that involves placing radioactive material inside your body.

Brachytherapy is one type of radiation therapy that's used to treat cancer. Brachytherapy is sometimes called internal radiation.

Brachytherapy allows doctors to deliver higher doses of radiation to more-specific areas of the body, compared with the conventional form of radiation therapy (external beam radiation) that projects radiation from a machine outside of your body.

Brachytherapy may cause fewer side effects than does external beam radiation, and the overall treatment time is usually shorter with brachytherapy.

Brachytherapy is used to treat several types of cancer, including:
  • Lung cancer
  • Bile duct cancer
  • Brain cancer
  • Breast cancer
  • Cervical cancer
  • Endometrial cancer
  • Esophageal cancer
  • Eye cancer
  • Head and neck cancers
  • Pancreatic cancer
  • Prostate cancer
  • Rectal cancer
  • Skin cancer
  • Soft tissue cancers
  • Vaginal cancer
Brachytherapy can be used alone or in conjunction with other cancer treatments. For instance, brachytherapy is sometimes used after surgery to destroy any cancer cells that may remain. Brachytherapy can also be used along with external beam radiation.

Risks
Side effects of brachytherapy are specific to the area being treated. Because brachytherapy focuses radiation in a small treatment area, only that area is affected.
You may experience tenderness and swelling in the treatment area. Ask your doctor what other side effects can be expected from your treatment.

How You Prepare
Before you begin brachytherapy, you may meet with a doctor who specializes in treating cancer with radiation (radiation oncologist). You may also undergo scans to help your doctor determine your treatment plan. Procedures such as X-rays or computerized tomography (CT) may be performed before brachytherapy.

What You can Expect
Brachytherapy treatment involves inserting radioactive material into your body near the cancer.

How your doctor places that radioactive material into your body depends on many factors, including the location and extent of the cancer, your overall health, and your treatment goals.

Placement may be inside a body cavity or into body tissue:
  • Radiation placed inside a body cavity. During intracavity brachytherapy, a device containing radioactive material is placed in a body opening, such as the windpipe or the vagina. The device may be a tube or cylinder made to fit the specific body opening. Your radiation therapy team may place the brachytherapy device by hand or may use a computerized machine to help place the device. Imaging equipment, such as a CT scanner or ultrasound machine, may be used to ensure the device is placed in the most effective location.
  • Radiation inserted into body tissue. During interstitial brachytherapy, devices containing radioactive material are placed within body tissue, such as within the breast or prostate. Devices that deliver interstitial radiation into the treatment area include wires, balloons and tiny seeds the size of grains of rice. A number of techniques are used for inserting the brachytherapy devices into body tissue. Your radiation therapy team may use needles or special applicators. These long, hollow tubes are loaded with the brachytherapy devices, such as seeds, and inserted into the tissue where the seeds are released. In some cases, narrow tubes (catheters) may be placed during surgery and later filled with radioactive material during brachytherapy sessions. CT scans, ultrasound or other imaging techniques may be used to guide the devices into place and to ensure they're positioned in the most effective locations.
High-dose-rate vs. low-dose-rate brachytherapy
What you'll experience during brachytherapy depends on your specific treatment.

Radiation can be given in a brief treatment session, as with high-dose-rate brachytherapy, or it can be left in place over a period of time, as with low-dose-rate brachytherapy. Sometimes the radiation source is placed in your body permanently.
  • High-dose-rate brachytherapy. High-dose-rate brachytherapy is often an outpatient procedure, which means each treatment session is brief and doesn't require that you be admitted to the hospital. During high-dose-rate brachytherapy, radioactive material is placed in your body for a short period — from a few minutes up to 20 minutes. You may undergo one or two sessions a day over a number of days or weeks. You'll lie in a comfortable position during high-dose-rate brachytherapy. Your radiation therapy team will position the radiation device, in the case of intracavity brachytherapy, or the radiation-holding device may already be in place if you're having interstitial brachytherapy.The radioactive material is inserted into the brachytherapy device with the help of a computerized machine. Your radiation therapy team will leave the room during your brachytherapy session. They'll observe from a nearby room where they can see and hear you.You shouldn't feel any pain during brachytherapy, but if you feel uncomfortable or have any concerns, be sure to tell your caregivers.Once the radioactive material is removed from your body, you won't give off radiation or be radioactive. You aren't a danger to other people, and you can go on with your usual activities.
  • Low-dose rate-brachytherapy. During low-dose-rate brachytherapy, a continuous low dose of radiation is released over time — from several hours to several days. You'll stay in the hospital while the radiation is in place.Radioactive material is placed in your body by hand or by machine. Brachytherapy devices may be positioned during surgery, which may require anesthesia or sedation to help you remain still during the procedure and to reduce discomfort.You'll likely stay in a private room in the hospital during low-dose-rate brachytherapy. Because the radioactive material stays inside your body, there is a small chance it could harm other people. For this reason, visitors will be restricted. Children and pregnant women shouldn't visit you in the hospital. Others may visit briefly once a day or so. Your health care team will still give you the care you need, but may restrict the amount of time they spend in your room. You shouldn't feel pain during low-dose-rate brachytherapy. Keeping still and remaining in your hospital room for days may be uncomfortable. If you feel any discomfort, tell your health care team. After a designated amount of time, the radioactive material is removed from your body. Once brachytherapy treatment is complete, you're free to have visitors without restrictions.
  • Permanent brachytherapy. In some cases, such as with prostate cancer brachytherapy, radioactive material is placed in your body permanently.The radioactive material is typically placed by hand with the guidance of an imaging test, such as ultrasound or CT. You may feel pain during the placement of radioactive material, but you shouldn't feel any discomfort once it's in place. Your body will emit low doses of radiation from the area being treated at first. Usually the risk to others is minimal and may not require any restrictions about who can be near you. In some cases, for a short period of time you may be asked to limit the length and frequency of visits with pregnant women or with children. The amount of radiation in your body will diminish with time, and restrictions will be discontinued.
Results
Your doctor may recommend scans after brachytherapy to determine whether treatment was successful. What types of scans you undergo will depend on the type and location of your cancer.

Source: Mayo Clinic
http://www.mayoclinic.org/tests-procedures/brachytherapy/basics/definition/prc-20021316