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Ambient Ozone Exposure and Pneumothorax Risk After CT-Guided Lung Biopsy
Nour Afilal1,2, Alois Komarek1, Michael Dieckmeyer1
1Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Rosenbühlgasse 27, 3010 Bern, Switzerland.
Tomography (Ann Arbor, Mich.)
|July 27, 2026
Summary
High ambient ozone levels may increase the risk of pneumothorax after CT-guided lung biopsy. A threshold of approximately 75.8 μg/m³ showed a significant association, while emphysema increased risk and access route through dependent lung area was protective.
Area of Science:
- Pulmonary Medicine
- Environmental Health
- Radiology
Background:
- Pneumothorax is a known complication of CT-guided lung biopsy.
- Environmental factors, such as air pollution, may influence post-procedural outcomes.
Purpose of the Study:
- To investigate the association between day-of-procedure ambient ozone exposure and pneumothorax risk following CT-guided lung biopsy.
- To identify potential thresholds of ozone exposure linked to increased pneumothorax incidence.
Main Methods:
- Retrospective analysis of 160 CT-guided lung biopsies.
- Correlation of biopsy dates with ambient ozone levels from national monitoring stations.
- Multivariable logistic regression models incorporating ozone exposure, emphysema, and access route through dependent lung area (ARDA).
Main Results:
- Pneumothorax occurred in 53.8% of biopsies; 8.1% required drainage.
- Ambient ozone was not linearly associated with pneumothorax.
- An exploratory threshold analysis indicated ozone ≥ 75.8 μg/m³ was associated with increased pneumothorax risk (OR, 2.76).
- Emphysema was associated with higher pneumothorax odds (OR, 2.16), while ARDA was protective (OR, 0.23).
Conclusions:
- Ambient ozone exhibits a potential nonlinear association with pneumothorax post-CT-guided lung biopsy, with a possible threshold effect around 70-80 μg/m³.
- Emphysema is a risk factor for drainage-requiring pneumothorax.
- ARDA demonstrates a protective effect against pneumothorax.
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