Interventional Pulmonology & Advanced Diagnostic Lung Program

Video: Carilion Clinic offers one of the most advanced bronchoscopy suites in western Virginia.

Carilion Clinic offers one of the most advanced Interventional and Diagnostic Programs of this nature in the country and the only such program in this region. The program is lead by Dr. Edmundo Rubio who brings over 15 years of experience in the field.

Dr. Rubio trained at Tulane University, where he later directed their Interventional Pulmonology Program. He brings years of experience dealing with complex airway and pleural diseases, including the use of rigid bronchoscopy and medical thoracoscopy. He also has training in advanced diagnostic techniques, such as electromagnetic navigational bronchoscopy and endobronchial ultrasonography.

Particular to our program, all difficult airway cases are discussed by Dr. Rubio with the rest of the team, prior to any intervention. We feel this team approach improves our patients' chances of having the best possible outcomes.


Our department has a simple policy when dealing with any patient referred for a newly diagnosed chest lesion or airway problem. We treat all of these as a priority with most patients being seen within five work days. Complex airway pathology is addressed within 24 hours, and when needed patients are rapidly admitted to our service. Our team will work also closely with ENT, thoracic surgery, radiation oncology and oncology, to ensure our patients received the best possible care.

We also expedite our patients' treatments through available on-site cytopathology. This allows not just improved diagnostic yields, but also more rapid establishment of diagnosis, which helps our oncologists to expedite therapy.


As noted, these complicated cases are performed by Dr. Rubio after discussions with the team. Many cases are performed under rigid bronchoscopy, allowing a more controlled environment. Both benign and malignant lesions are treated, and a multidisciplinary approach is utilized. As such, patients may be referred to radiation therapy or surgery when determined that these options may be better than a bronchoscopic intervention.

To ensure the best possible outcomes, all our patients are also closely evaluated by a dedicated team of anesthesiologist who supports each of our procedures. Highly trained nurse anesthetists and nurses are also available in each case.

We particularly welcome highly complex airway lesions, many times being able to offer therapeutic alternatives, when these have not been deemed available elsewhere.


In 2011 we designed and opened a new suite to accommodate advanced bronchoscopic procedures. This is an ample room that allows us to perform both pleural and airway procedures, under general anesthesia when required. The suite is equipment with modern diagnostic and therapeutic equipment. Additionally, as one of the most 'wired' hospital systems in the country we have access to all imaging studies through an integrated PACS system. Fluoroscopy is also readily available. Finally, ultrasonography is routinely used to guide pleural procedures.


Advanced Diagnostic Bronchoscopy

  • Endobronchial ultrasonography
  • Electromagnetic navigational bronchoscopy
  • Narrow-band imaging bronchoscopy (NBI)
  • Cryobiopsy
  • Ultrasound guided biopsies of non-pulmonary pathology adjacent to the airways

Interventional Bronchoscopy

  • Rigid bronchoscopy
  • ND-YAG laser photoresection
  • Photodynamic therapy
  • Brachytherapy (intraluminal radiation) for airway tumor compromise
  • Argon plasma coagulation for tumor ablation and cauterization
  • Airway balloon dilation for in tracheal or bronchial narrowing
  • Cryotherapy for re-canalization of airway narrowing due to tumors
  • Cryotherapy for tumor destruction
  • Endobronchial electrocautery for coagulation and destruction of airway tumors
  • Placement of airway valves for the treatment of bronchopleural fistulas
  • Stent placement for airway narrowing, to include self-expandable and silicone stents, including Y stents for advanced complex airway involvement by tumor
  • Stent removal/revision
  • Transtracheal oxygen catheter placement to treat severe hypoxemia and reduce work of breathing
  • Foreign body removal

Interventional Pleural Diseases

  • Placement of large bore chest tubes
  • Placement of indwelling catheters for chronic drainage of pleural fluid
  • Placement of Heimlich valves for drainage of pneumothoraces
  • Ultrasound-guided pleural mass biopsy
  • Ultrasound guided thoracentesis of pleural effusions
  • Instillation of fibrinolytic agents for complex effusions
  • Medical thoracoscopy


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Take a Virtual Tour of the Endoscopy Suite


Patients will arrive for procedures at the fourth floor ambulatory entrance of Carilion Roanoke Memorial Hospital. Valet parking is available.


Patients will have private rooms before and after their procedures. A family member is allowed to join them in this room.


This is an example of one of our procedure rooms where bronchoscopies are performed. Each room is equipped with diagnostic and anesthesia equipment.


This is another example of one of our procedure rooms where bronchoscopies are performed.


The fourth floor ambulatory entrance includes a large waiting area for patient, family members, and friends.


An alternate view of the fourth floor ambulatory entrance.


Before returning to their private patient room, patients will spend some time in our post-operative recovery room. This is where they can be closely monitored after a procedure.


Patients will first enter a pre-operative room before their procedure. This is where pre-testing information is taken and patients can discuss any questions about the procedure with their healthcare providers.