A Technological Difference Cont.

Three new additions to Dr. Nutting’s suite — a fluoroscopy angiography machine by GE, a 54-inch flat screen monitoring system by Carrot Medical, and an electromagnetic navigation system by Veran Medical Technologies — has taken his already highly-recognized treatment to the next level.

To explain his Veran IG4, Dan Blais, a support director with the company, says: "Think of it as a NeverLost. Our needle is the car, and our system is like the satellite up in space. Basically, we are re-creating a GPS in a smaller environment."

The re-creation begins with a CT scan of the patient’s treatment area, such as the chest cavity of a patient Dr. Nutting was doing a lung-tumor biopsy on recently. The CT data is then downloaded to the IG4. Next, technicians place three small pads on the patient in a triangle around the procedure area. When the doctor begins, the pads sense his needle movement, transferring the data to the IG4, which overlays the information on a CT image. "It creates a three-dimensional virtual model of the patient, and after that, you really don’t need to use any X-ray guidance," Dr. Nutting says.

A Visual Revolution

"I can see where that needle is going to go before I ever put it in," Dr. Nutting says. "You line up through trajectory. It will show me where my target is, and it will allow me to advance the needle as I’m virtually watching it go in." Before, a CT scan would have to be taken every time Nutting moved the needle. Now, only one scan is generally needed. "So it’s less X-ray for the patient, and it’s a faster and safer procedure," Dr. Nutting says.

The new GE system, which is digital rather than analog, provides higher image quality. "You can see more using less radiation," says Tom Marlborough of GE Healthcare. And the flat screen by Carrot, which nearly runs the length of the patient bed, provides Dr. Nutting a real-time, integrative view.

"Before having this technology, I would have to think in my mind where the tumor was. I’d run back to the computer room to look at a screen, and I’d go back in and do the angiogram. Now what I can do is look up on the screen and view integrated images from the patient’s prior CT scan, MRI, PET scan. Everything is right in front of me."

Dr. Nutting, who completed the biopsy on the lung-tumor patient in fewer than 10 minutes, says his procedure time is cut in half. And the technology allowed him to perform the biopsy in the minimally-invasive manner because of its pinpoint accuracy — the patient’s tumor was precariously close to his aorta.

A Cancer Breakthrough

Greater accuracy also makes a difference in treating his main patient population: liver-cancer patients, who comprise 90 percent of his patient load. Whether it’s primary liver cancer, on the rise along with hepatitis C, or metastasized cancer from other areas of the body, such as the colon or the breast, more end-stage liver-cancer patients are benefiting from a growing arsenal of innovative treatments delivered through Dr. Nutting’s minimally-invasive means.

"The electro-magnetic guidance system allows us to get up into tumors that we could not previously treat," he says. "I now have free range of motion of that needle to get to my virtual target, which is revolutionizing the way we do treatment." Sky Ridge Medical Center is noted as one of the top five institutions in the country for SIR-Spheres microspheres therapy for patients with inoperable liver tumors. Dr. Nutting was the first in the nation to perform the radioembolization treatment, in which radioactive micro-particles are injected into liver tumors. The powerful beads work to kill only the tumor, creating little damage to surrounding areas.

"This allows a high dose to the tumor with a low dose to the body, leading to a more effective treatment along with a higher quality of life," Dr. Nutting says. Initial data shows colon-cancer patients whose disease has spread to the liver live an additional 14 months when this therapy is combined with traditional chemotherapy. Other treatments can be added to extend life even longer, he says.

"And most all of these things are locally targeted therapies with decreased systemic toxicity," Dr. Nutting says. "We’re providing hope in patients who have been told there’s nothing else that can be done, and we’re providing quality of life."