Neil Thornbury (Host): Welcome to Pulse and Perspectives, the show that brings you the heartbeat of healthcare innovation and the vantage point of industry leaders. I'm your host, Neil Thornbury, CEO of T.J. Regional Health. In this special podcast episode, I'm joined by one of our expert pulmonologists here at T.J. Regional Health, Dr. Omar Mahmoud.

Today, we'll be discussing an exciting breakthrough in pulmonary care, the Ion robotic bronchoscopy system. This cutting edge procedure uses advanced robotic precision to navigate deep into the lungs, areas that were once difficult to reach, allowing for earlier detection and treatment of conditions such as lung cancer and lung disease. We'll explore how this innovation technology leads to faster, more accurate diagnosis and helps open up a pathway to better outcomes for patients facing serious lung diseases.

So I'd like to thank Dr. Mahmoud for taking time out of his very busy schedule, especially on a Monday afternoon in the midst of this holiday, if you will, virus that's going around, this kind of pulmonary virus that everybody's faced with in this unusual time of year. But Dr. Mahmoud, if you will, tell us a little bit about, what is the Ion robotic bronchoscopy system?

Dr. Omar Mahmoud: Okay. Very good. Well, thank you very much, first off, for having me on. The Ion robotic navigational bronchoscopy is a really exciting piece of technology that uses a proprietary software that allows us to use a patient's CAT scan to make a GPS map of their lungs. And using a robotic arm, we manipulate a very thin, flexible lung catheter into the patient's airway and navigate towards a lesion or a nodule an area of interest within the patient's lung.

Host: So, tell me how that differs, and I know we've just been doing this over the last several months in our organization, but how does it differ from more of the traditional bronchoscopy procedures and what makes it different?

Dr. Omar Mahmoud: Well, a traditional bronchoscopy, the bronchoscope that we use is larger in diameter, so thicker, and not as long. And it's completely operated by hand, it's manually operated. And so, we would slide our camera into the patient's airway, but you could only get so far. Usually, with a traditional bronchoscope, you can examine the main airway, meaning your trachea, your windpipe, and the subsegments or the small segments that branch off your main airway, but you can't get very deep. And the majority of lung cancers occur a little bit deeper into the lung in the upper lung zones, often to the periphery of the lung. So, there's a lot of territory that you can't cover with a traditional bronchoscope. So, what this does is allows us in a very precise way to not only reach areas of interest that are much further out into the lung, but allows us to park our catheter there so that we can introduce tools to allow us to take precise biopsies.

Host: So, from what you've seen, and you've been doing this procedure some time now, as you've trained and now executed many of these procedures, tell us a little bit about what kind of difference have you seen since you've been using this as it relates to identifying, early treatment, those types of approaches.

Dr. Omar Mahmoud: Well, you could think of a lot of the lesions that we have access to now exist in a region in the lung, which is often difficult to access or had been previously, I should say. Before, if you had a nodule that was very deep in the lung, you might have to go to an interventional radiologist to have a biopsy done through the chest wall, meaning from the outside of the body through in between the ribs with what we call a CT-guided biopsy while you're in a CAT scan machine. That has a higher rate of pneumothorax or collapsed lung. And it's not as ideal because you're not able to perform staging of a cancer within the same procedure. If you contrast that to what we do now, we're able to go after very small lesions from the inside of the patient while they're under anesthesia, get very precise biopsies. And then, let's say we're able to diagnose cancer right then and there, we can then follow the robotic portion of the case with a more traditional bronchoscopy inside the main portion of the airway where we access the patient's lymph nodes and can sample those as well all in the same procedure. So in a very short amount of time, you're able to get the patient a lot of information from just one session, and then that helps to really expedite their road to treatment.

Host: So, you bring up a couple of points that I think are really interesting to me and I know one reason that you are a huge advocate for moving our organization and especially our pulmonary program in this direction. One, in the past, if I'm right, with this specific type of procedure and technology, it really allows you and the team to be able to keep patients here, be a lot more effective and a lot quicker in regards to getting the patient what they need when they need it. Speak to that a little bit. What were you doing prior to, and how has this changed the way you've practiced for patients in this region.

Dr. Omar Mahmoud: Well, really, it's been a big game changer. Prior to us having this technology here at T.J., if you had a nodule that was, let's say, located kind of right in the center of the lung tissue, a little too deep to be accessed from the outside of the body with a CT-guided biopsy, and a little too far away from the main airway to access with a traditional bronchoscope, then really you had to be referred to a center that had this technology, which for a long time was Louisville, which with the time change, as well as, you know, just the overall distance driving, that was a big deterrent for a lot of patients and it made access very difficult. And as you can imagine, places like Louisville, they have a very huge catchment area, which means longer wait times to see the subspecialist doctor there. So now, with this technology here, we're able to see patients and get them in for an appointment and biopsied within one week, which is a really amazing turnaround time.

Host: Yeah. And for us, that is everything, especially in what we would consider very much so rural Kentucky. Access is very important. Travel cannot be understated here. Cause there's so many of our patients they have a difficult time getting to our clinics and our hospital system, much less trying to travel an hour and a half in any direction to try to go get any care anywhere else.

So, to your point, access is fantastic and this is certainly bringing that. So in the time that you've been doing this, give us kind of, if you will, a view behind the door, what have you seen, some specific cases that really you've gotten some outcomes that you were just like, "This is exactly why I wanted to bring this here because of the timeliness, because of the effectiveness, tell us a little bit about that.

Dr. Omar Mahmoud: Well, I think one of the areas where this technology shines the most is when you find a very small, lesion on a CAT scan. And, you know, we live in an area where obviously there's a high incidence of smoking. And therefore, high incidence of lung cancer, one of the highest in the country, actually. But also, we live in an area where histoplasmosis and other fungi are endemic. And so, lot of people have nodules that are benign also, but look very suspicious, let's say, on a CAT scan when you consider the fact that they may have a smoking history as well. So, this technology helps us to differentiate between malignant or cancerous disease and benign diseases as well. We've been able to detect cancers that are less than a centimeter in size, which is considered really small and been able to refer those patients rather quickly to a surgeon for a definitive therapy and surgical resection or surgically removing those cancers, which is really the best outcome that you could hope for in a lung cancer. So, there's been countless patients so far that we've either been able to put at ease by proving to them that they have benign disease or getting them pointed in the right direction for a surgical intervention really early.

Host: Excellent. I mean, truly, as you would say, it is very much a game-changer for our patients in a lot of different ways. Especially when you think about every single patient, you think about, "Hey, this is my mother," "This is my father," "This is my child," "This is my spouse," when you have that type of concern, you want to have answers as quickly as you possibly can. And at least a direction with options as quickly as you possibly can, which is what this robotic system and this system does, which I can go on and on about the importance of that, especially as it relates to every single patient that we have. So, let's talk about at the patient level, you mentioned cancer. Are there other patients that you utilize this for or who is it specifically kind of the area or the population that you think, "I need to take them in for this procedure?"

Dr. Omar Mahmoud: Well, actually, you know, it's such an amazing tool in that it really allows you to very precisely target an area of interest. We often use it for really any CT, or CAT scan abnormality that persists. And so, we find a lot of inflammatory conditions such as organizing pneumonia. We find all sorts of infectious causes, not only fungal disease, but also non-tuberculous mycobacterial disease, which is also common. So really, from inflammatory lung conditions to infectious lung conditions to malignancies, really, you can target anything that's of interest.

Host: And now, just from the general understanding of this as it relates to the population, and you touched on some of these, but are there potential risks, limitations of the device that, again, just as a patient or consumer, I would want to know?

Dr. Omar Mahmoud: Well, you know, the nice part about this technology, what's so new about it, is the navigational component, meaning how do we create a really nice map of your lungs and how do we get to the area? But the actual tools that we use and the actual biopsies that we perform are the same that we've performed historically. We use forceps, we use a very small needle. And whether you biopsy a lesion from the inside of the lung or from the outside of the lung, there are the same major risks, which are risks of bleeding, risks of causing a collapsed lung or pneumothorax. And in the case of doing this bronchoscopically or through a bronchoscopy, the risk of anesthesia.

The risks of bleeding and the risks of, in particular, pneumothorax, are lower than if you were to do them, let's say, by a CT-guided biopsy. So, are there risks associated with it like any procedure? Yes. But in general, it's actually a lot safer of a way for us to get these diagnoses. And again, while it does involve general anesthesia, you're able to do the staging part of the procedure all in one session. So, it allows you to get really a lot out of one procedure.

Host: Excellent. So now, let me spin ahead here as we move and you see technologies coming out in your field of practice, how do you see the robotic bronchoscopy and other similar technologies kind of shaping the future for pulmonary medicine?

Dr. Omar Mahmoud: Well, for one thing, I think in this area in particular, but of course, like in a national scale and in a world scale as well, I think it's going to allow us to diagnose cancers a lot earlier, and that's going to allow us to have much better outcomes for lung cancer in general, that we can identify things sooner and get people pointed in the right direction.

Host: Now, I would say, kind of opening the mic to you, what are some other thoughts? What would you like to share with the audience of anything specific about the Ion system or just in general?

Dr. Omar Mahmoud: Well, I think, probably the biggest thing that having this technology has allowed us to do, as I mentioned before, is come up with diagnoses very early on. And part of that is having patients engage and ask their doctors about low-dose lung cancer screening. If they have a smoking history of more than 20 pack years, meaning one pack of cigarettes per day for 20 years or some equivalent of that. And they're over the age of 50, then they should talk with their doctors about low-dose lung cancer screening, because that's where we get the most benefit from a technology like this. If we find an area that looks suspicious while it's very small, then we can have a much better outcome. So, I think raising awareness of the importance of that, I think it's a big part of our future here at T.J. and in our community, and will really allow us to put this technology forth and get the most out of it.

Host: Truly, truly amazing. Innovation as it relates to pulmonary medicine and our hospital system. And, again, just things that I would like to share to the audience, Dr. Mahmoud first, came to our hospital right in the era of what we would all consider the Covid era, which was a very challenging. And at that time, most hospitals, including our hospital, was really looking for guidance and somebody to champion us through that process.

And again, you're talking about a lung disease that came in as a pandemic. And then our pulmonologist coming in to a very difficult situation, which Dr. Mahmoud did, and really championed our whole community through that process with his colleagues, and even since then continues to champion things like this Ion robotic system, which really is amazing. So, I can tell you from my perspective and from my seat, I'm very fortunate to work with somebody of his talent level. Our community is very fortunate to have somebody like him in our community because of what he does and what he brings to the community. And this is just another example of that.

So, thank you, Dr. Mahmoud. I certainly appreciate all that you've done. I certainly appreciate your time today and sharing a little bit about this neat technology and innovation, truly.

Dr. Omar Mahmoud: It's been my pleasure.

Host: So, thank you for tuning in to Pulse and Perspectives. It's my pleasure to have Dr. Mahmoud with us today, sharing his insights on the Ion robotic bronchoscopy and the healthcare innovations transforming patient care. For more discussions like this, make sure you subscribe to our podcast on your favorite platform. Please share it on your social media channels. I'm Neal Thornbury. And until next time, keep your pulse on the future and keep your perspectives wide open. Thank you.