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A Comparative Study of Radiation Exposure in Conventional and Robotic Bronchoscopy
Nakul Ravikumar1, Elliot Ho2, Gaurav Ajmani3
1Division of Pulmonary and Critical Care, University of Massachusetts Chan Medical School-Baystate, Springfield, MA.
Background:
It remains unclear whether radiation exposure to bronchoscopists and staff differs between conventional and robotic-assisted bronchoscopy (RAB).
Research Question:
Does the radiation dose received by the bronchoscopist and team members differ between fluoroscopically guided conventional bronchoscopy and RAB?
Study Design And Methods:
This prospective study evaluated radiation exposure during conventional and RAB with fluoroscopy. Radiation dose was measured per the International Commission on Radiological Protection and National Council on Radiation Protection and Measurements guidelines.
Results:
Over a 10-month period, 54 fluoroscopy-guided bronchoscopies were analyzed: 15 conventional bronchoscopies and 39 RABs. Among the RABs, 27 used C-arm-based tomosynthesis (CABT) and 12 used standard C-arm fluoroscopy (CF). The median total radiation exposure per case was highest for RAB using CABT (0.237 vs 0.065 vs 0.02 mSv) compared with conventional bronchoscopy and RAB with CF, respectively (P = .025). The comparison of radiation exposure per case between conventional bronchoscopy and RAB with CF showed no difference (P = .33). RAB with CABT resulted in significantly higher radiation exposure to the operator's skin underneath the thyroid collar (median, 0.0022 mSv/min; P = .007), whereas both conventional bronchoscopy and RAB with CF had negligible exposure at this site (0 mSv/min; P = .18). Radiation dose to staff (nurses, bronchoscopy technicians, pathologists, and anesthesiologists) was minimal across all procedure types. Patients with BMI > 35 kg/m2 had significantly higher dose area product/min (5.1 Gy·cm2; P = .0067), with no differences observed based on nodule size, CT scan pattern, or location.
Interpretation:
Our results show that in this prospective study applying a rigorous methodology to measure and compare radiation doses, we did not find an overall reduction in operator radiation exposure with RAB when only conventional fluoroscopy was used. The addition of CABT was associated with significantly increased radiation dose. The maximum number of RABs using these external imaging modalities performed per year should align with the current regulatory authorities' recommendations.
