Feasibility of Using the O-Arm Imaging System During ENB-rEBUS–guided Peripheral Lung Biopsy

Abstract

Background: There is a paucity of real-time imaging modalities available for the bronchoscopic biopsy of peripheral lung nodules. We aim to demonstrate the feasibility of the O-arm imaging system to guide real-time biopsies of peripheral lung nodules during electromagnetic navigation bronchoscopy. Methods: A retrospective review was performed at 2 academic medical centers utilizing O-arm guidance. Results: The average nodule size was 2.1×2.0 cm and were mostly solid (66%) with a positive bronchus sign (83%). O-arm imaging confirmed tool-in-lesion in all cases. The diagnostic yield was 33%. Four cases were nondiagnostic of the 6 cases performed. In these cases, necrotic tissue was the most common (75%) and showed resolution following subsequent imaging. The average 3-dimensional (3D) spin time was 23.5 seconds. The average number of 3D spins performed per case was 4.33. The average effective dose per 3D spin was 3.73 mSv. Conclusion: We have demonstrated the O-arm’s feasibility with electromagnetic navigation bronchoscopy for peripheral lung nodules. The O-arm was able to confirm tool-in-lesion in all cases which added confidence to the biopsy. Four high-resolution 3D spins per case may limit the total computed tomography effective dose. We also noted that both metal and radiation scatter were minimal when appropriate radiation safety standards were met. Although additional experience and data will be required to verify the O-arm approach for routine use, our initial experience is promising.

O-arm CT for Confirmation of Successful Navigation During Robotic Assisted Bronchoscopy

“…17 In addition, O-arm CT has recently been described as a technically feasible option for use during ENB. 18 The use of O-arm CT during RAB has not previously been described. Here we present a retrospective review of our experience using O-arm CT during RAB for secondary confirmation of successful navigation to lung lesions.…”

The Feasibility of Using the “Artery Sign” for Pre-Procedural Planning in Navigational Bronchoscopy for Parenchymal Pulmonary Lesion Sampling

“…We describe the concept of using the “artery sign” as a surrogate for “bronchus sign” when planning navigation pathways for ENB and RAB. Navigational bronchoscopy software continues to improve [ 21 ] and advanced imaging techniques continue to develop and be implemented in bronchoscopy, including augmented fluoroscopic navigation technology [ 22 ], O-arm [ 23 ] and cone-beam CT [ 5 ]. Until then, the ability of the operator to recognize and plan a pathway from the central airway to the target lesion is relevant for optimizing yield.…”

The Road to 90

“…One such imaging system is cone-beam computed tomography (CBCT) with augmented fluoroscopy, which has been shown to provide a significant diagnostic boost (∼14%) to ENB than ENB alone. 5 However, CBCT is not widely available for bronchoscopists; therefore, alternative auxiliary imaging modalities 6,7 such as O-arm and tomosynthesis-assisted fluoroscopic ENB have been used to assist ENB. The uptick in diagnostic yield, however, does come at a cost of increased radiation exposure with these devices.…”