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CT in the Operating Room Allows More Accurate Removal of Small Lung Tumors

By MedImaging International staff writers
Posted on 15 May 2014

A new technique that employs computed tomography (CT) imaging in the operating room (OR) should allow surgeons to effectively delineate and remove small, sub-centimeter lung nodules, leaving as much healthy tissue as possible.

Raphael Bueno, MD, from Brigham and Women’s Hospital (Boston, MA, USA), presented the findings at the 94th American Association of Thoracic Surgery (AATS) annual meeting in Toronto (ON, Canada), on April 30, 2014.

Lung cancer remains the most lethal cancer. A recent study, the US National Lung Cancer Screening Trial indicated that screening with low-dose computed tomography (CT) scans in smokers, who have certain risk factors, may decrease the number of deaths. Lung cancer screening with CT can detect many small lung lesions that can potentially be cancerous and should be removed surgically. The objective is to remove these small lung tumors, but at the same time spare as much healthy lung as possible. To achieve this, requires being able to precisely determine the exact location of the nodule and its margins.

“These results are exciting and promising, indicating that image-guided lung surgery could play a significant role in the treatment of lung cancer,” noted Dr. Bueno. “This surgical approach has the potential to increase accuracy and reduce errors. It is like using GPS [global positioning system] to navigate to the destination and perform a true surgical strike.”

In this phase I/II clinical study conducted in conjunction with researchers from Siemens Healthcare (Erlangen, Germany), 20 patients who had small pulmonary nodules in the outer half of the lung were identified. Earlier CT scans showed that the lesions were very small, ranging from 0.6–1.8 cm. The nodules were so tiny that they could not be easily palpated or visualized.

Using a CT scanner in the operating room, surgeons first marked the identified location of the lung nodules by inserting two small markers (T-bars) through the skin and placing them next to the nodule. The markers have attached wires that make them visible to surgeons during the resection process. This technique is safe and effective for nodule localization and all patients underwent total removal of the lesions with minimal removal of healthy lung tissue, according to the investigators.

“We propose that image-guided, video-assisted thoracic surgery [IVATS] can be used to improve the ability to precisely identify small pulmonary nodules and allow for resections of sub-centimeter nodules,” concluded Dr. Bueno.

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61 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

62 (138.0443572998): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

63 (733.1371307373): SELECT fid FROM jos_deeppockets WHERE id=294752441 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752441 AND published='1' LIMIT 1

64 (63.896179199219): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

65 (87.02278137207): select jos_twitters.link from jos_twitters where cat=10

66 (56.982040405273): select jos_facebook.link from jos_facebook where cat=10

67 (193.11904907227): select jos_google_plus.link from jos_google_plus where cat=10

68 (43.869018554688): select jos_linkedin.link from jos_linkedin where cat=10

69 (!!!!! 1739.9787902832): SELECT fid FROM jos_deeppockets WHERE id=294752441 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752441 AND published='1' LIMIT 1

70 (94.890594482422): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

71 (!!!!! 3576.0402679443): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (633.00132751465): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (94.890594482422): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 1471.0426330566): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (669.00253295898): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (49.829483032227): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (36.954879760742): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

91 (!!!!! 2114.0575408936): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (94.890594482422): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (55.789947509766): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 3785.8486175537): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

106 (151.8726348877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

107 (!!!!! 4059.0763092041): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294752441 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (885.96343994141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294752441 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 1164.9131774902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

110 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

111 (919.81887817383): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294752441 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (619.17304992676): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294752441 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (744.81964111328): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (382.90023803711): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

116 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

117 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

118 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

119 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

120 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

121 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

122 (!!!!! 3760.814666748): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

123 (770.09201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752441 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752441 AND type='deeppockets_item' AND published='1' LIMIT 1

124 (!!!!! 14261.00730896): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

125 (73.909759521484): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (57.93571472168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

127 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (97.990036010742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

129 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (380.03921508789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

131 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (!!!!! 2383.9473724365): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

133 (83.208084106445): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (687.83760070801): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (510.93101501465): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (72.002410888672): SELECT name FROM jos_deeppockets WHERE id=211

137 (44.107437133789): SELECT name FROM jos_deeppockets WHERE id=211

138 (910.04371643066): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (!!!!! 3693.1037902832): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (224.82872009277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

141 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

142 (!!!!! 2339.8399353027): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

143 (159.97886657715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

144 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

145 (!!!!! 3342.1516418457): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

146 (!!!!! 3921.9856262207): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

147 (!!!!! 2978.0864715576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

148 (154.01840209961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

149 (79.870223999023): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752441 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752441 AND type='deeppockets_item' AND published='1' LIMIT 1

150 (56.028366088867): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

151 (46.968460083008): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

152 (66.995620727539): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

153 (!!!!! 3082.9906463623): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

154 (185.96649169922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752441 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752441 AND published='1' LIMIT 1

155 (109.91096496582): select jos_twitters.link from jos_twitters where cat=10

156 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

157 (42.915344238281): select jos_google_plus.link from jos_google_plus where cat=10

158 (42.200088500977): select jos_linkedin.link from jos_linkedin where cat=10

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