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

Augmented fluoroscopy (AF) and C-arm-based tomography (CABT) have enhanced diagnostic outcomes in navigated bronchoscopy, though there is limited documentation on radiation dose trends.

A two-year prospective study with 67 cases was conducted. Patients underwent bronchoscopy biopsies with AF and CABT under general anesthesia. AF used a GE C-arm 9900, and lesion localization was done with Body Vision's CABT system. Radiation doses were measured using cumulative air kerma (CAK), dose area product (DAP), effective dose (ED), and fluoroscopy time (FT) over three two-month phases.

The average lesion size was 2.1 cm, with a diagnostic yield of 72 % (48/67) using strict criteria. Intermediate criteria, including follow-up CT, increased the yield to 84 % (56/67). Radiation doses averaged CAK 42 mGy, DAP 27 Gy cm², ED 5 mSv, with 7 min of FT and 1.7 rotations per lesion. Over the study, FT increased (4-7 min), but CAK (54-44 mGy) and DAP (34-26 Gy cm²) decreased. Significant associations with increased CAK radiation doses were found with multiple C-arm spins (P = 0.03), tool adjustments (P = 0.01), BMI above 30 (P = 0.01), extended FT (P = 0.04), higher DAP (P = 0.04), and increased ED (P < 0.001).

AF and CABT provide high diagnostic yield with minimal radiation exposure. Pulsed fluoroscopy and careful technique can reduce radiation risk, supporting the use of AF and CABT in navigated bronchoscopy for lung nodules.