Radiation in the Bronchoscopy Suite: One Center's Experience With Navigational Bronchoscopy and a Review of the Literature.

Abstract

Background: This study aimed to quantify radiation doses during navigational bronchoscopy procedures, comparing them with reported cohorts and evaluating the LungVision (Body Vision Medical Inc.) system's efficacy in dose reduction.

Methods: This retrospective observational study included 52 consecutive navigational bronchoscopy cases, categorized into 4 imaging groups based on the C-arm: Cios Spin (Siemens Healthineers), or OEC 9900 (GE HealthCare); and the 3D tomographic imaging algorithm: Cios Spin's onboard imaging, or LungVision's AI-driven imaging. Patient and lesion data, outcomes, and radiation indices were collected. Existing literature on 3D image guidance for bronchoscopic lung nodules was reviewed to compare reported radiation doses.

Results: Combining LungVision with Cios Spin significantly reduced radiation dose in all cases compared with using Cios Spin alone: Cumulative air kerma (Ka,r) reduced from 238.7 to 119.1 mGy (P=0.03), and air kerma-area product (KAP) decreased from 28.19 to 15.09 Gy·cm2 (P=0.03). For biopsy cases, LungVision led to notable dose reductions: Ka,r of 279 to 129.1 mGy, and KAP of 30.70 to 16.27 Gy·cm2. LungVision notably reduced radiation indices in 7 paired spins, isolating the 3D imaging algorithm as the sole variable with the same Cios Spin C-arm. A literature review provides additional context on radiation for bronchoscopic biopsies.

Conclusion: Following the "as low as reasonably achievable" (ALARA) principle minimizes ionizing radiation exposure, benefiting patients and operators. Physicians should compare baseline radiation levels with the literature and adopt dose-reduction techniques. LungVision's lower dose indices render it effective for real-time 3D imaging during navigational bronchoscopy while reducing radiation dose.