Lung cancer is the deadliest form of cancer in the U.S., killing more people each year than colorectal, breast and prostate cancers combined. In 2021, experts predict that lung cancer will cause over 131,000 deaths in the U.S.
“This is a very sobering reality, especially since we’re located in the southeast in the tobacco belt,” said Veronica Getz, assistant vice president of Atrium Health’s Critical Care and Respiratory Health. “It also highlights the need to find ways to detect lung cancer earlier and help patients move through the health system quickly to get the care they deserve.”
“When it comes to lung cancer, the earlier the diagnosis – the better the outcome,” explained Jeffrey Hagen, MD, chief of thoracic surgery at Atrium Health Sanger Heart & Vascular Institute and director of thoracic surgical oncology at Atrium Health Levine Cancer Institute. “To improve lung cancer outcomes, we provide comprehensive, multidisciplinary care with a focus on early detection, state-of-the-art diagnostics and superior treatments.”
Atrium Health’s Pulmonary Medicine team, in partnership with Sanger Heart & Vascular Institute, Levine Cancer Institute, Radiology and Emergency Medicine, rolled out a new initiative that includes software to track patients for incidental lung nodules and for preventative annual lung screening using low-dose computed tomography (CT). In addition, a new robotic tool allows for minimally invasive and more accurate lung biopsies.
Systematic software monitoring
Since August 2017, Atrium Health’s Lung Screening Program has identified patients at high risk for lung cancer and enrolled them to be screened annually. In February 2021, Atrium Health’s new Incidental Lung Nodule Program began to manage patients with incidental lung nodules.
Both lung programs are focused on early detection of lung cancer and are headquartered at the Jan & Ed Brown Center for Pulmonary Medicine in Uptown Charlotte. According to Dr. Hagen, Atrium Health offers the only comprehensive, formal programs in the Charlotte region that provide early detection using CT screening and incidental nodule detection.
When patients are scanned for conditions unrelated to the lungs that affect the neck, chest or abdomen, imaging may reveal incidental lung nodules. “While lung nodules are very common, the vast majority are not cancerous,” said John Doty, MD, pulmonologist and medical director of the Incidental Lung Nodule Program and the Lung Screening Program. “By consulting our group of experts, including our pulmonologists and specialized advanced practice providers, we can identify what seems more suspicious and needs further evaluation.”
According to Dr. Doty, studies show that about 30% of all CT scans reveal an incidental finding, and only about 30% of incidental pulmonary nodules are followed up on according to national guidelines. Working with Charlotte Radiology, he estimated that in 2019, almost 20,000 incidental pulmonary nodules may have been discovered. Because of this, the Incidental Lung Nodule Program was developed to identify patients with incidental nodules through artificial intelligence software. “It was important to manage those patients with a navigation team and through a database to ensure early detection of lung cancer,” Dr. Doty explained.
After evaluating several options, program leaders decided to purchase a highly innovative, state-of-the art tracking software. In February 2021, the program began a multiphase software implementation (6 phases total; 2 per quarter) to ensure proper testing and improvements along the way.
Here’s how the tracking software works:
- The software scans every radiology report stored in the imaging database, looking for keywords such as lung mass, pulmonary lesion, etc. When the software flags a scan containing 1 or more of the targeted keywords, it adds the scan to the tracking database. (Radiologists helped the software team refine the list of key terms that the software tracks.)
- Nurse navigators check the tracking database daily to identify lung nodules that may need investigating.
- For nodules less than 6 mm, the navigator forwards the information to the patient’s primary care doctor for follow-up.
- For larger nodules, the navigator recommends the patient for a pulmonary consult.
- A data coordinator keeps track of all patients with incidental lung nodule findings.
Teammate training and software refinements have been vital to the tool’s success. “It’s been a relationship-building process for all parties to ensure these technologies aid our multidisciplinary care teams, including radiology, emergency medicine, primary care, and pulmonary, to move quickly with detection and diagnosis,” Getz related. “The software is only as good as what we’re training it to do. We spent several weeks customizing the software and refining its sensitivity to meet our patients’ needs.”
“After refinements at our pilot sites, we plan to use the software to monitor patients throughout our organization," explained Dr. Doty. “This will allow us to provide expert pulmonary care that’s close to home.”
What are the results so far? “In the first 11 weeks, the software generated 2,000 alerts, notifying nurse navigators about 488 patients with incidental findings,” revealed Getz. “Of those patients, nearly 200 of them needed follow-up from our navigation team and 70 of them needed pulmonary consults. So far, we’ve diagnosed a few cancers in the lungs and other sites.”
State-of-the-art robot
When imaging reveals a concerning lung nodule, a biopsy may be needed for an accurate diagnosis. Historically, traditional bronchoscopy has not been consistently successful in performing biopsies for small or peripheral lung nodules, which are located deep within the lung tissue. In the past, pulmonologists also had to decide if the benefits of using a CT biopsy outweighed the risk of complications.
As minimally invasive technology evolves, robotic bronchoscopy offers a safer, quicker approach that is adaptable to the needs of patients, including those with high-risk lung conditions. In support of this technology movement, a minimally invasive robot for navigational bronchoscopy arrived at Atrium Health on May 17, 2021.
“The new robot adds to our expertise in minimally invasive lung procedures and advanced diagnostics, making areas where we were already succeeding even better,” said Jaspal Singh, MD, medical director of pulmonary innovation and oncology at Levine Cancer Institute. “In fact, the team at Atrium Health Carolinas Medical Center currently does the highest volume of advanced diagnostic bronchoscopy procedures in the Charlotte region.” Dr. Hagen added, “We’re one of the only hospitals in the region using advanced diagnostics, including a robotic bronchoscope.”
To help diagnose cancer as soon as possible, the robot provides exceptional accuracy and precision during a biopsy. “It allows us to reach more precise locations within the lungs, providing easier access to peripheral areas located near the heart, by large blood vessels or deep in the chest,” Dr. Singh related. “Because the machine can hold its position, it frees up our hands and allows us to make adjustments during the procedure and biopsies, all while maintaining precision and control.”
Prior to the arrival of the bronchoscopy robot, the Pulmonary Medicine team was using other advanced diagnostic tools while surgeons at Atrium Health were performing robot-based surgical procedures. In the future, Atrium Health plans to start using similar bronchoscopic robots in the operating room and other areas throughout the organization.
Robust care team
The new software and robot are part of Atrium Health’s programs for the early detection of lung cancer. They are designed to support the overall care team, including pulmonologists, thoracic surgeons, radiologists and oncologists.
“Regardless of where patients enter our system, we can easily transfer them to the appropriate expert to provide the best, most efficient care,” explained Getz. “Through this technology investment, we have elevated the capabilities of our robust care team members who work so well together. The new tools are really the cherry on top.”
Learn more
Learn more about the lung nodule program and lung cancer screening program at Atrium Health. To refer a patient for robotic bronchoscopy, contact the Jan and Ed Brown Center for Pulmonary Medicine at 704-355-5375.
