Cargando…

Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves

BACKGROUND: The endobronchial diagnosis of peripheral lung lesions suspected of lung cancer remains a challenge from a navigation as well as an adequate tissue sampling perspective. Cone-beam computed tomography (CBCT) guidance is a relatively new technology and allows for 3-dimensional imaging conf...

Descripción completa

Detalles Bibliográficos
Autores principales: Verhoeven, Roel L.J., van der Sterren, William, Kong, Wens, Langereis, Sander, van der Tol, Pieternel, van der Heijden, Erik H.F.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460082/
https://www.ncbi.nlm.nih.gov/pubmed/34162799
http://dx.doi.org/10.1097/LBR.0000000000000783
_version_ 1784571670678208512
author Verhoeven, Roel L.J.
van der Sterren, William
Kong, Wens
Langereis, Sander
van der Tol, Pieternel
van der Heijden, Erik H.F.M.
author_facet Verhoeven, Roel L.J.
van der Sterren, William
Kong, Wens
Langereis, Sander
van der Tol, Pieternel
van der Heijden, Erik H.F.M.
author_sort Verhoeven, Roel L.J.
collection PubMed
description BACKGROUND: The endobronchial diagnosis of peripheral lung lesions suspected of lung cancer remains a challenge from a navigation as well as an adequate tissue sampling perspective. Cone-beam computed tomography (CBCT) guidance is a relatively new technology and allows for 3-dimensional imaging confirmation as well as navigation and biopsy guidance, but, also involves radiation. This study investigates how radiation exposure and diagnostic accuracy in the CBCT-guided navigation bronchoscopy evolves with increasing experience, and, with a specific tailoring of CBCT and fluoroscopic imaging protocols towards the procedure. PATIENTS AND METHODS: In this observational clinical trial, all 238 consecutive patients undergoing a CBCT-guided navigation bronchoscopy from the start of our CBCT-guided navigation bronchoscopy program (December 2017) until June 2020 were included. Procedural dose characteristics and diagnostic accuracy are reported as a function of time. RESULTS: Procedural radiation exposure as measured by the dose area product initially was 47.5 Gy·cm(2) (effective dose: 14.3 mSv) and gradually reduced to 25.4 Gy·cm(2) (5.8 mSv). The reduction in fluoroscopic dose area product was highest, from 19.0 Gy·cm(2) (5.2 mSv) to 2.2 Gy·cm(2) (0.37 mSv, 88% reduction), despite a significant increase of fluoroscopy time. The diagnostic accuracy of navigation bronchoscopy increased from 72% to 90%. CONCLUSION: A significant learning effect can be seen in the radiation safety and diagnostic accuracy of a CBCT-guided and augmented fluoroscopy–guided navigation bronchoscopy. With increasing experience and tailoring of imaging protocols to the procedure, the procedural accuracy improved, while the effective dose for patients and staff was reduced.
format Online
Article
Text
id pubmed-8460082
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-84600822021-09-28 Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves Verhoeven, Roel L.J. van der Sterren, William Kong, Wens Langereis, Sander van der Tol, Pieternel van der Heijden, Erik H.F.M. J Bronchology Interv Pulmonol Original Investigations BACKGROUND: The endobronchial diagnosis of peripheral lung lesions suspected of lung cancer remains a challenge from a navigation as well as an adequate tissue sampling perspective. Cone-beam computed tomography (CBCT) guidance is a relatively new technology and allows for 3-dimensional imaging confirmation as well as navigation and biopsy guidance, but, also involves radiation. This study investigates how radiation exposure and diagnostic accuracy in the CBCT-guided navigation bronchoscopy evolves with increasing experience, and, with a specific tailoring of CBCT and fluoroscopic imaging protocols towards the procedure. PATIENTS AND METHODS: In this observational clinical trial, all 238 consecutive patients undergoing a CBCT-guided navigation bronchoscopy from the start of our CBCT-guided navigation bronchoscopy program (December 2017) until June 2020 were included. Procedural dose characteristics and diagnostic accuracy are reported as a function of time. RESULTS: Procedural radiation exposure as measured by the dose area product initially was 47.5 Gy·cm(2) (effective dose: 14.3 mSv) and gradually reduced to 25.4 Gy·cm(2) (5.8 mSv). The reduction in fluoroscopic dose area product was highest, from 19.0 Gy·cm(2) (5.2 mSv) to 2.2 Gy·cm(2) (0.37 mSv, 88% reduction), despite a significant increase of fluoroscopy time. The diagnostic accuracy of navigation bronchoscopy increased from 72% to 90%. CONCLUSION: A significant learning effect can be seen in the radiation safety and diagnostic accuracy of a CBCT-guided and augmented fluoroscopy–guided navigation bronchoscopy. With increasing experience and tailoring of imaging protocols to the procedure, the procedural accuracy improved, while the effective dose for patients and staff was reduced. Lippincott Williams & Wilkins 2021-10 2021-06-23 /pmc/articles/PMC8460082/ /pubmed/34162799 http://dx.doi.org/10.1097/LBR.0000000000000783 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Original Investigations
Verhoeven, Roel L.J.
van der Sterren, William
Kong, Wens
Langereis, Sander
van der Tol, Pieternel
van der Heijden, Erik H.F.M.
Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves
title Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves
title_full Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves
title_fullStr Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves
title_full_unstemmed Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves
title_short Cone-beam CT and Augmented Fluoroscopy–guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves
title_sort cone-beam ct and augmented fluoroscopy–guided navigation bronchoscopy: radiation exposure and diagnostic accuracy learning curves
topic Original Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460082/
https://www.ncbi.nlm.nih.gov/pubmed/34162799
http://dx.doi.org/10.1097/LBR.0000000000000783
work_keys_str_mv AT verhoevenroellj conebeamctandaugmentedfluoroscopyguidednavigationbronchoscopyradiationexposureanddiagnosticaccuracylearningcurves
AT vandersterrenwilliam conebeamctandaugmentedfluoroscopyguidednavigationbronchoscopyradiationexposureanddiagnosticaccuracylearningcurves
AT kongwens conebeamctandaugmentedfluoroscopyguidednavigationbronchoscopyradiationexposureanddiagnosticaccuracylearningcurves
AT langereissander conebeamctandaugmentedfluoroscopyguidednavigationbronchoscopyradiationexposureanddiagnosticaccuracylearningcurves
AT vandertolpieternel conebeamctandaugmentedfluoroscopyguidednavigationbronchoscopyradiationexposureanddiagnosticaccuracylearningcurves
AT vanderheijdenerikhfm conebeamctandaugmentedfluoroscopyguidednavigationbronchoscopyradiationexposureanddiagnosticaccuracylearningcurves