Cutting doses, keeping diagnoses: outcomes of protocol optimization for CT-guided lung biopsies

To assess changes in patient radiation exposure during computed tomography (CT)-guided lung biopsies before and after protocol optimization and to evaluate the potential impact of this optimization on diagnostic yield and biopsy duration.

In this single-center retrospective study, analysis of dose-length product (DLP), biopsy duration and diagnostic performance included data from 200 biopsies-100 performed before and 100 after protocol optimization. Evaluation of operator-specific DLP included additional data from 22 biopsies, and DLP trend analysis incorporated data from 221 supplementary biopsies. Statistical significance was set at p < 0.05.

Following protocol optimization, the median DLP decreased significantly from 576.5 (486.8-653.0) to 62.0 (53.0-73.0) mGycm (p < 0.001). All operators demonstrated a significant reduction in DLP (p < 0.01). Diagnostic performance was similar before and after optimization: sensitivity, specificity and PPV remained unchanged at 87.2%, 100.0% and 100.0%, respectively. NPV and accuracy increased slightly from 50.0% and 88.7% before optimization to 54.6% and 88.9% post-optimization. Standard deviation of operator DLP means decreased by 64.8% (from 169.8 to 59.8 mGycm). DLP for all operators decreased gradually before optimization, with a sharp and sustained reduction over the next 2 years. No significant change was observed in biopsy duration-12.0 (10.0-16.5) versus 14.0 (11.0-17.0) minutes (p = 0.11).

Protocol optimization is a feasible way to reduce patient radiation exposure and achieve safer lung biopsies under CT guidance without compromising diagnostic performance or procedure duration.