The Additional Accuracy Gained by Cone Beam CT in Shape-Sensing Robotic Bronchoscopy

Area of Science:

• Pulmonology
• Medical Imaging
• Robotic Surgery

Background:

• Robotic-assisted bronchoscopy (RAB) utilizes real-time adjustments for enhanced accuracy.
• Cone beam CT (CBCT) provides intraprocedural 3D imaging of biopsy tools relative to lesions.

Purpose of the Study:

• To evaluate the accuracy of biopsy needle placement in pulmonary nodules using shape-sensing RAB alone versus RAB with CBCT guidance.
• To determine if CBCT enhances the precision of robotic bronchoscopy.

Main Methods:

• 102 pulmonary nodules were biopsied using shape-sensing RAB.
• Needle position relative to the nodule center was assessed using CBCT.
• Repositioning occurred after 1-2 CBCT adjustments based on 3D imaging.

Main Results:

• RAB alone achieved center placement in 26.5% of nodules.
• Adding CBCT significantly improved needle proximity to the lesion center (P < .001).
• Radial endobronchial ultrasound images improved from eccentric to concentric.

Conclusions:

• CBCT integration with RAB substantially improves biopsy tool accuracy in pulmonary nodules.
• This enhanced accuracy may increase the reliability of diagnostic and therapeutic bronchoscopic interventions.