Real-time AR navigation with dynamic tracking for millimeter-level pulmonary nodule localization: A randomized...

Precise localization of small pulmonary nodules is crucial for surgery. Augmented reality (AR) navigation provides real-time guidance, potentially improving localization efficiency. This open-label randomized controlled trial compares AR-guided localization with conventional computed tomography (CT)-guided localization in 168 participants with peripheral pulmonary nodules ≤2 cm. The primary outcome is localization accuracy; secondary outcomes are success rate, procedural time, radiation dose, insertion attempts, and complications. In the intention-to-treat population, the AR group shows significantly lower localization error than the CT group (4.50 ± 3.07 vs. 6.50 ± 3.54 mm), with shorter procedural time, lower radiation exposure, and fewer needle adjustments. Both groups show high success rates and similar complication rates, with no severe adverse events. AR-guided localization provides noninferior accuracy while reducing radiation exposure and procedural time, supporting an efficient alternative to CT guidance. The trial is registered at www.clinicaltrials.gov (NCT06335563).