Radiation exposure trends with augmented fluoroscopy and C-arm-based tomosynthesis for navigated bronchoscopy

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Respiratory medicine Pub Date : 2025-03-11 DOI:10.1016/j.rmed.2025.108035

Roshen Mathew , Winnie Elma Roy , Nikhil Meena , Harmeen Goraya

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Abstract

Background

Augmented fluoroscopy (AF) and C-arm-based tomography (CABT) have enhanced diagnostic outcomes in navigated bronchoscopy, though there is limited documentation on radiation dose trends.

Methods

A two-year prospective study with 67 cases was conducted. Patients underwent bronchoscopy biopsies with AF and CABT under general anesthesia. AF used a GE C-arm 9900, and lesion localization was done with Body Vision's CABT system. Radiation doses were measured using cumulative air kerma (CAK), dose area product (DAP), effective dose (ED), and fluoroscopy time (FT) over three two-month phases.

Results

The average lesion size was 2.1 cm, with a diagnostic yield of 72 % (48/67) using strict criteria. Intermediate criteria, including follow-up CT, increased the yield to 84 % (56/67). Radiation doses averaged CAK 42 mGy, DAP 27 Gy cm², ED 5 mSv, with 7 min of FT and 1.7 rotations per lesion. Over the study, FT increased (4–7 min), but CAK (54–44 mGy) and DAP (34–26 Gy cm²) decreased. Significant associations with increased CAK radiation doses were found with multiple C-arm spins (P = 0.03), tool adjustments (P = 0.01), BMI above 30 (P = 0.01), extended FT (P = 0.04), higher DAP (P = 0.04), and increased ED (P < 0.001).

Conclusions

AF and CABT provide high diagnostic yield with minimal radiation exposure. Pulsed fluoroscopy and careful technique can reduce radiation risk, supporting the use of AF and CABT in navigated bronchoscopy for lung nodules.

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导航支气管镜中增强透视和c臂断层合成的辐射暴露趋势。

背景：增强透视（AF）和基于c臂的断层扫描（CABT）增强了导航支气管镜的诊断结果，尽管关于辐射剂量趋势的文献有限。方法：对67例患者进行为期两年的前瞻性研究。患者在全身麻醉下行AF和CABT支气管镜活检。AF使用GE C-arm 9900，病灶定位使用Body Vision的CABT系统。辐射剂量测量采用累积空气克氏度（CAK）、剂量面积积（DAP）、有效剂量（ED）和透视时间（FT）三个两个月的阶段。结果：平均病变大小为2.1 cm，采用严格的诊断标准，诊断率为72%（48/67）。中间标准，包括随访CT，将良率提高到84%（56/67）。辐射剂量平均为CAK 42 mGy， DAP 27 Gy·cm2, ED 5 mSv， FT时间为7分钟，每个病变旋转1.7次。在整个研究过程中，FT增加（4 ~ 7分钟），但CAK （54 ~ 44 mGy）和DAP （34 ~ 26 Gy·cm2）下降。c臂多次旋转（P = 0.03）、工具调整（P = 0.01）、BMI大于30 （P = 0.01）、FT延长（P = 0.04）、DAP升高（P = 0.04）和ED升高（P < 0.001）与CAK辐射剂量增加有显著相关。结论：AF和CABT以最小的辐射暴露提供了较高的诊断率。脉冲透视和谨慎技术可以降低辐射风险，支持在导航支气管镜检查肺结节时使用AF和CABT。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.