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Patient profile

A 68-year-old patient was found to have a 16 mm lesion in the left upper lung (LUL) adjacent to the aorta. The patient has a smoking history of 40 pack-years and a history of squamous cell carcinoma of the head and neck. The differential diagnosis is considered to be metastatic squamous cell carcinoma or newly diagnosed primary lung cancer.

Nodules adjacent to major blood vessels have always been a challenge for diagnosis and treatment. Limited by previous levels of visualization and navigation accuracy, procedures involving these lesions have historically been high-risk. Based on clinical feedback, the Galax system's integrated 3D Imaging DT technology improves the accuracy of reaching nodules near the aorta, obtaining diagnostically usable tissue specimens while maintaining a safe path, thus reducing the risks associated with sacrificing safety. "— Dr. Matthew Warner, Prisma Health-Richland"

CT scan digital tomography 3D reconstruction

Preoperative CT scan of a nodule in the left upper lung (LUL) adjacent to the aorta

Clinical benefit

Biopsies of nodules adjacent to vital structures such as the aorta present a key challenge: ensuring the biopsy tool is precisely positioned within the specific area of ​​the lesion while maintaining a sufficient safe distance between the tool and the blood vessel to guarantee the accuracy and safety of the procedure. Dr. Wana, leveraging the high-precision positioning capabilities of the Galaxy system, clearly visualized the boundary between the left upper lung (LUL) lesion and the aorta, and effectively marked the updated lesion location in the 3D Imaging DT reconstructed image, providing data support for enhanced fluoroscopy. Through distance quantification, the physician could definitively confirm that the tool had reached the interior of the lesion and was far from the blood vessel, thus confirming the diagnosis of squamous cell carcinoma for the patient.

Case Report

Left upper lung (LUL) nodule adjacent to the aorta

Digital tomography 3D reconstruction with enhanced perspective

Doctors use a compatible C-arm to perform a medium-angle scan with the lesion as the isocenter to collect imaging data.

Distance quantification confirmation tools are used within the lesion, and enhanced fluoroscopy confirmation tools are used within the lesion.

The distance quantification function can confirm that the biopsy tool is located within the lesion from various angles  through multi-position imaging (AP, left anterior oblique 45°, right anterior oblique 45°), providing confidence for subsequent operations.

diagnosis

Rapid on-site assessment (ROSE) indicated malignancy, and the diagnosis was squamous cell carcinoma, suggesting head and neck cancer metastasis (stage IV).

Case Highlights  

The 0.16mm lesion was clearly displayed in digital tomography 3D Imaging DT. 

With the help of the Galaxy system's distance quantization and enhanced X-ray vision capabilities, multiplanar confirmation of the biopsy tool's location within the lesion was achieved. 

The entire 40-minute surgery maintained clear visualization, including instrumental scanning of the lesion and the entire ROSE sampling process. 

Image data was acquired and generated using a mobile CBCT device and a low-dose fluoroscopy protocol.  

Images and case details provided by: Dr. Matthew Philip Warner, Prisma Health-Richland Medical Center. © 2025 Noah Medical. All rights reserved. Document No.: ML-1463-EN-v2. Some content has been modified for compliance with regulations regarding medical device advertising.