Cone beam computed tomography for navigational bronchoscopy

Cone beam computed tomography (CBCT) is a revolutionary technology that is increasingly being used in interventional pulmonology for the diagnosis and treatment of pulmonary lesions, specifically small peripheral pulmonary lesions (PPLs). CBCT systems can provide detailed three-dimensional (3D) imaging, allowing for 3D lesion as well as instrument positioning information. Currently, only the fixed CBCT systems have been studied as a tool to not only provide 3D scanning information but also allow overlaying information on live fluoroscopy by a feature called augmented fluoroscopy. Using this combination of scanning and augmentation, CBCT can be used as a modality that provides both imaging and guidance in navigation to target lesions in navigation bronchoscopy. Studies have shown that the addition of CBCT to navigation bronchoscopy using other primary navigation guidance techniques can further increase the diagnostic yield of these technologies. The combination of CBCT with robotic assisted bronchoscopy (RAB) is one of the most promising combinations, allowing pulmonologists to navigate complex airways with distal tip control along with detailed 3D positioning information to obtain biopsies and correct for computed tomography (CT)-to-body divergence. It is important for physicians to be properly trained in the use of CBCT, in order to obtain a high diagnostic yield with a low complication rate and to limit radiation exposure to the patient and employees. While further research is needed to fully examine its potential and address challenges, CBCT will likely become the standard of care technology for a wide range of diagnostic and therapeutic procedures in interventional pulmonology. More research needs to be done on the added value and need of CBCT in combination with advanced procedural guidance techniques such as RAB.