Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple.

Summary

Bronchoscopy is a medical procedure where a doctor uses a flexible or rigid tube with a camera (bronchoscope) to look inside the airways and lungs. The procedure may involve using fluoroscopic guidance (real-time X-ray imaging) to place small markers called fiducial markers, which help guide future treatments like radiation therapy.

Purpose

This procedure is used to diagnose and treat problems in the airways and lungs. The placement of fiducial markers helps to accurately target tumors during radiation therapy, improving treatment precision.

Indications

• Persistent cough or bloody sputum
• Suspected lung cancer or tumors
• Chronic lung infections
• Abnormal imaging results (e.g., X-ray, CT scan)

Preparation

• Patients are usually instructed to fast for several hours before the procedure.
• Medication adjustments may be necessary, particularly for blood thinners.
• Diagnostic tests such as blood work or imaging studies are often required beforehand.

Procedure Description

1. The patient is given sedation or general anesthesia.
2. A bronchoscope (flexible or rigid) is inserted through the nose or mouth into the lungs.
3. Fluoroscopic guidance may be used to navigate and visualize the airways.
4. Fiducial markers are placed at the target site(s) within the lungs.
5. The bronchoscope is removed, and the patient is brought out of sedation/anesthesia.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Bronchoscopy is usually performed in a hospital's endoscopy suite or a specialized outpatient clinic.

Personnel

• Pulmonologist or thoracic surgeon
• Nurses
• Anesthesiologist or nurse anesthetist
• Radiology technician (for fluoroscopy)

Risks and Complications

• Bleeding
• Infection
• Pneumothorax (collapsed lung)
• Reactions to anesthesia
• Rare risk of damage to airways or lungs

Benefits

• Accurate diagnosis and treatment planning
• Precise placement of fiducial markers for targeted radiation therapy
• Minimal invasiveness compared to surgical options

Recovery

• Patients are monitored for a few hours post-procedure.
• Instructions may include rest, avoiding strenuous activities, and follow-up appointments.
• Full recovery is typically within a day or two, although some discomfort may persist.

Alternatives

• Non-invasive imaging techniques (e.g., CT scan, MRI)
• Needle biopsy (less invasive but limited in diagnostic capability)
• Surgical biopsy (more invasive but provides comprehensive tissue analysis)

Patient Experience

• During the procedure, patients typically don't feel anything due to sedation or anesthesia.
• Post-procedure, mild sore throat, cough, or hoarseness may be experienced.
• Pain management is offered, and any discomfort is usually short-lived.