Tumor Hunt: the Sequel in 3D

How advanced technology is helping Mary Greeley become a leader in early lung cancer detection.

The patient had survived cancer a few years ago, but now a CT scan had revealed a suspicious nodule in their lung.

Finding out if the nodule was cancerous quickly was imperative given the patient’s previous history. But it was tiny, just 6 millimeters. A potentially dangerous dot hidden in the patient’s lung.

A biopsy was ordered using navigational bronchoscopy. Mary Greeley began offering this specialized procedure last year. What was different about this patient’s procedure though is that it would be done with a new 3D C-arm. It has cone beam CT capability, which means it can rotate around the patient, providing fast, low-radiation 3D imagery.

Navigational bronchoscopy is performed with the aid of a surgical robot at Mary Greeley by Dr. Tamim Mahayni and Dr. Taher Sabobeh, both McFarland Clinic pulmonologists. It is a valuable tool when a potential tumor is small and deep inside the lung. What makes it even more valuable is how it integrates with the 3D C-arm, a state-of-the-art fluoroscopy tool that provides real time images of the patient’s anatomy, aiding the pulmonologist’s hunt for tiny tumors.

“The addition of a 3D C-arm with cone beam CT capability is a significant advancement for our bronchoscopy program,” says Dr. Sabobeh, who performed the procedure on the cancer survivor. “It allows us to obtain real-time, high-resolution, three-dimensional imaging during procedures, which greatly enhances our ability to accurately localize pulmonary nodules.”

Having this early-cancer-detection technology available for central Iowans now is significant as Iowa has one of the highest lung cancer rates in the country.

Overall, the technology enhances both the precision and safety of advanced robotic navigational bronchoscopy, ultimately improving patient outcomes, says Sabobeh.

Dr. Taher Sabobeh, a McFarland Clinic pulmonologist, reviews images provided by a 3D C-arm, which is integrated with a robotic device used for navigational bronchoscopies.

Navigational Bronchoscopy

During a conventional bronchoscopy, a scope goes through a patient’s vocal cords and into the airway, providing a view of their bronchial tubes. It is CT-guided, which still is appropriate in certain situations. The benefit of a CT-guided biopsy is that it is controlled by a radiologist, who can target a lesion with the CT scanner.

The challenge with a CT biopsy, however, is that it involves a needle going through the rib cage and then through lung tissue, which can increase the risk of bleeding and lung collapse.

Navigational bronchoscopy solves this problem by using a computer to map out the airway, which enables Mahayni and Sabobeh to guide instruments to within a few millimeters of the lesion that’s being targeted.

In other words, its goes further into the airways, enabling biopsies to be taken of nodules or lung masses that might be difficult to reach otherwise. As Mahayni said in a 2025 Health Connect article about the procedure: “It's one of those things in medical technology that I think is going to advance the field, particularly as it relates to lung cancer.”

Navigational bronchoscopies are performed with an Ion robot made by Intuitive, which is the same company that produces daVinci surgical robots the medical center has used for many years.

3D C-arm

After a mass, tumor or nodule in the lung tissue has been identified through a CT scan, a computer program maps a path through the lung’s airways for an ultrathin catheter. The goal is to get as close to the lesion as possible.

When a patient has a CT, however, they may be in a different position than when they are in the operating room. This is where the 3D C-arm comes into play. The 3D capabilities aid with what is called CT-to-body divergencies. The device, which is shaped like the letter C, spins around the patient, providing real-time images, enabling the pulmonologists to make small adjustments to ensure they quickly reach the small target.

“We have a good idea of where the lesion is, but not the exact location. The navigational bronchoscopy robot integrates with the 3D C-arm to help us along the way, sort of like a GPS, except the destination is a potentially cancerous lesion,” says Dr. Sabobeh.

Once the lesion location is pinpointed, the pulmonologist can use tools to collect biopsy samples, which are immediately analyzed by a pathologist present in the operating room.

The lesion Dr. Sabobeh biopsied on the cancer survivor mentioned earlier in this story was found to be cancerous.

“That was a not the news we were hoping for,” said Dr. Sabobeh. “But we found the tumor quickly, at stage 1, which gives her oncologist an opportunity to develop an early treatment plan. This is our goal with this technology: Finding tumors when they are small, before they grow and spread.” ■

Finding Cancer Earlier

The combination of the robotic navigational bronchoscopy with the 3D C-arm offers patients a range of benefits, including:

• Improved diagnostic accuracy. “We can confidently biopsy much smaller and more peripheral lung nodules that were previously difficult to reach,” says Dr. Taher Sabobeh, McFarland Clinic pulmonologist.
• Earlier detection of lung cancer. This is especially important for identifying early-stage disease when curative treatment is still possible.
• Reduced complications. Better visualization helps minimize risks such as pneumothorax (collapsed lung).
• Shorter, more efficient procedures. Real-time confirmation reduces the need for repeat biopsies or additional procedures.
• Faster and more precise staging. It also helps in identifying metastatic disease earlier, allowing for timely and appropriate treatment planning.

Lung Cancer Screening

You may be eligible for a lung cancer screening if you:

• Are 50 to 80 years old
• Have a 20 pack-a-year smoking history
• Currently smoke cigarettes or quit within the past 15 years

If you answer ‘yes’ to these questions, ask your primary care provider about getting a lung cancer screening. These screenings can indicate your current risk for lung cancer, and, in some cases, detect potential tumors so they can be treated early.

Quit Smoking

Need help to stop smoking? McFarland Clinic offers tobacco cessation services.

Kaitlyn Baumgardner, DNP, FNP-C, of McFarland Clinic Oncology & Hematology is trained in treating patients for tobacco cessation, including counseling and medication management. She says anyone who wants to quit tobacco is eligible for these services.

“This service is for anyone who wants to quit tobacco products,” says Baumgardner. “We just ask that you’d be willing to try quitting your tobacco product as well as willing to follow up.”

Learn more at mcfarlandclinic.com/stoptobacco.