Broncus makes RSNA debut with lung navigation software

Dec 15, 2009

Sure, you've heard of virtual colonoscopy. But could the next big trend in advanced visualization be virtual bronchoscopy?

That's the goal of Broncus Technologies, a Mountain View, CA, company that made its RSNA debut last week. The firm is commercializing a suite of software applications designed to make minimally invasive biopsies of the lungs more effective through the use of image-guided navigation.

Broncus has been around for 10 years, with a focus on treatments for airway diseases such as emphysema and lung cancer. The company has set itself apart by basing its approach to lung treatment on minimally invasive devices, in contrast to the pharmaceutical approaches that tend to dominate lung treatment, according to Cary Cole, CEO of the company.

The problem with minimally invasive therapy is that pulmonologists and thoracic surgeons can sometimes get lost when guiding catheter-based devices through the delicate intricacies of the pulmonary system, especially given factors such as patient movement during respiration. Medical imaging data such as CT can help, but lung specialists aren't as adept as radiologists in making the correlation between 2D slices and actual human anatomy.

To solve this problem, Broncus two years ago licensed technology covering the development of a virtual bronchoscopy system based on CT data. The technology was developed at the Penn State Hershey Medical Center in Hershey by William E. Higgins, Ph.D., and forms the basis of the company's LungPoint line of software applications.

Broncus offers LungPoint in two configurations: LungPoint Procedure Planning and LungPoint Virtual Bronchoscopy Navigation. Cole compares the two to the difference between using printed directions from MapQuest to plan a car trip (Procedure Planning) and using a GPS that offers you real-time information giving your car's location at any time (Virtual Bronchoscopy Navigation).

Both applications take CT data (preferably 1-mm slices) to construct 3D volumes of the lung. Lung physicians using Procedure Planning can scroll through CT slices, select an area of suspicious lung tissue as a target, and view a virtual bronchoscopic animation of the software's calculated path to the target.

With Virtual Bronchoscopy Navigation, the system displays virtual bronchoscopy data side-by-side with real-time bronchoscopy images. The target location and major vessels are overlaid on the airways, and physicians can take notes or capture screen shots.

This video demonstrates fiber-optic bronchoscopy image (left) with virtual bronchoscopy image (right). Colored lines indicate pathways to target calculated by LungPoint software. Video supplied by Broncus Technologies.

Having trouble viewing this clip?
Click here to view full size clip or to change format

An advantage of LungPoint is that the software works with minimally invasive devices from any vendor, in addition to the company's own Yield line of catheters.

LungPoint is in operation at six sites in the U.S. and Europe, with sales ramping up in 2010.

A radiology focus

Although pulmonologists and thoracic surgeons would be the primary users of LungPoint technology, Broncus recently realized that radiologists are also a key target market. Besides just providing the CT data to create virtual bronchoscopy images, radiologists might be interesting in acquiring LungPoint systems to provide better service to referring physicians and expand their referral network, Cole said.

"This benefits radiologists because they are integral in providing CT images and CT reads," Cole said. "They want to provide better services in a way that their competitors can't."

A radiology group using Broncus technology might have a LungPoint server installed in its office. A radiologist would read CT lung images on his or her usual diagnostic workstation, then send the data to the LungPoint server and select a target location for the minimally invasive therapy.

The software would then calculate the most appropriate route to the therapy location through the airways, and a pulmonologist or thoracic surgeon at another office could log on to the server using a thin-client PC to view the information. In they're not satisfied with the radiologist's selection of a target, referring physicians can suggest alternate targets, and the LungPoint server will calculate different pathways in an interactive fashion.

Whether a site uses LungPoint Procedure Planning or LungPoint Virtual Bronchoscopy Navigation depends on budgets -- the procedure planning workstation runs about $35,000, while the navigation system costs around $150,000.

As the company recognized the importance of radiology, it began hiring a number of executives with experience in medical imaging, many of whom came from Lumisys, a Silicon Valley firm that manufactured film digitizers and computed radiography systems until it was acquired by Eastman Kodak in 2000.

These include Cole himself, who co-founded CompuRad, one of the first teleradiology software developers, which later was acquired by Lumisys. Another CompuRad co-founder, Henky Wibowo, is vice president of R&D at Broncus, while CompuRad/Lumisys veteran Dean MacIntosh serves as CFO and Terese Bogucki as senior director of marketing.

Broncus decided to exhibit at last week's RSNA conference to further establish relationships in radiology. The company has a direct sales force to sell LungPoint in the lung disease market but is open to OEM deals, particularly with radiology vendors, Cole said.

Ultimately, Broncus sees the LungPoint software as helping chest physicians develop minimally invasive techniques similar to those developed in interventional radiology and cardiology, Cole said.

"Pulmonology and thoracic surgery is moving the way that interventional radiology moved 10 years ago, and interventional cardiology 15 years ago, where doctors are now doing interventions," Cole said. "We want a good win-win situation between radiologists, pulmonologists, and thoracic surgeons."

By Brian Casey
AuntMinnie.com staff writer
December 16, 2009