Improving Shape-Sensing Robotic-Assisted Bronchoscopy Outcomes with Mobile Cone-Beam Computed Tomography Guidance.

Area of Science:

• Pulmonology
• Medical Imaging
• Interventional Bronchoscopy

Background:

• Computed tomography to body divergence (CTBD) poses a significant challenge for diagnosing peripheral lung nodules via bronchoscopy.
• Cone-beam CT (CBCT) guidance is increasingly used to address CTBD and improve diagnostic outcomes.
• Mobile CBCT (m-CBCT) integration with robotic bronchoscopy is being evaluated for enhanced efficacy.

Purpose of the Study:

• To evaluate the impact of adding mobile cone-beam CT (m-CBCT) guidance to shape-sensing robotic-assisted bronchoscopy (SS-RAB).
• To assess the improvement in tool-in-lesion (TIL) rates and diagnostic yield for peripheral lung nodules.
• To compare the performance of SS-RAB alone versus SS-RAB combined with m-CBCT.

Main Methods:

• A prospective, single-arm study enrolled patients with peripheral lung nodules (1-3 cm).
• The study compared the rates of TIL and diagnostic yield between SS-RAB alone and SS-RAB with m-CBCT guidance.
• Data on complications and radiation dose (dose-area product) were collected.

Main Results:

• Tool-in-lesion (TIL) rates increased from 34.3% with SS-RAB alone to 98.6% with the addition of m-CBCT (p < 0.0001).
• Diagnostic yield improved significantly from 29.9% (SS-RAB alone) to 86.6% (SS-RAB with m-CBCT) (p < 0.0001).
• No pneumothoraxes or bronchoscopy-related complications were reported; median DAP was 50.5 Gy-cm².

Conclusions:

• The integration of m-CBCT guidance with SS-RAB effectively compensates for CTBD.
• This combination substantially increases both TIL rates and diagnostic yield for peripheral lung nodules.
• The approach offers improved diagnostic capabilities with acceptable radiation exposure.