Cone-beam computed tomography augmented-fluoroscopy-guided center-strike targeting during peripheral bronchoscopy: robotic vs. manual catheters
Year: 2026
Type: article
Abstract: Background: Computed tomography (CT)-to-body divergence and tool-tissue divergence (TTD) limit bronchoscopic access to peripheral pulmonary lesions (PPLs). Fixed cone-beam CT (CBCT) with augmented fluoroscopy (AF) enables intraprocedural target segmentation, live fluoroscopic overlay, and confirmation of tool position. We describe three CBCT AF-guided spatial targeting techniques as a targeting workflow and compare manual pre-curved and shape-sensing robotic catheters using center strike as the primary technical endpoint. Methods: This retrospective single-center study included 200 consecutive patients with 219 biopsied PPLs. The first 100 patients underwent biopsy with manual pre-curved catheters (Medtronic; 106 lesions), followed by 100 patients who underwent biopsy using a shape-sensing robotic catheter (Intuitive; 113 lesions). All procedures used fixed CBCT-AF, a ventilation protocol with apneic breath-holding, needle targeting with traditional two-angle, slow-sweep, and/or center-datum techniques, and CBCT tool-position confirmation. Center strike was defined as needle position in the middle third of the lesion on axial, sagittal, and coronal CBCT images. The primary outcome was center-strike tool position; diagnostic yield and 1-year diagnostic accuracy were secondary outcomes. Results: , P=0.04], without significant differences in fluoroscopy time or number of CBCT spins. Two pneumothoraces occurred in the robotic cohort, one requiring chest tube placement. Conclusions: A CBCT AF-guided targeting workflow combines real-time needle-vector alignment with intraprocedural confirmation of tool position before tissue sampling. Within this workflow, robotic catheters achieved higher center-strike and TIL rates and were associated with improved diagnostic performance. Reliable intraprocedural spatial confirmation may become increasingly important as bronchoscopy evolves toward precision transbronchial therapies.
Source: Journal of Thoracic Disease
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223301763