Radiation exposure trends with augmented fluoroscopy and C-arm-based tomosynthesis for navigated bronchoscopy

Area of Science:

• Medical Imaging
• Pulmonology
• Radiation Oncology

Background:

• Augmented fluoroscopy (AF) and C-arm-based tomography (CABT) improve diagnostic outcomes in navigated bronchoscopy.
• Limited data exists on radiation dose trends associated with these advanced imaging techniques.

Purpose of the Study:

• To prospectively evaluate diagnostic yield and radiation dose trends of AF and CABT in navigated bronchoscopy.
• To identify factors influencing radiation dose during these procedures.

Main Methods:

• A two-year prospective study involving 67 patients undergoing bronchoscopy with AF and CABT.
• Radiation doses measured via cumulative air kerma (CAK), dose area product (DAP), effective dose (ED), and fluoroscopy time (FT).
• GE C-arm 9900 and Body Vision's CABT system were utilized for lesion localization.

Main Results:

• Diagnostic yield was 72% (strict criteria) and 84% (intermediate criteria).
• Average radiation doses: CAK 42 mGy, DAP 27 Gy cm², ED 5 mSv, FT 7 min.
• Fluoroscopy time increased, while CAK and DAP decreased over the study period.
• Increased radiation dose correlated with multiple C-arm spins, tool adjustments, higher BMI, extended FT, higher DAP, and increased ED.

Conclusions:

• AF and CABT achieve high diagnostic yield with manageable radiation exposure.
• Pulsed fluoroscopy and meticulous technique are key to minimizing radiation risks.
• These findings support the clinical utility of AF and CABT in navigated bronchoscopy for lung nodule diagnosis.