An Assessment of Effective Radiation Dose When Utilizing the Illumisite System for Evaluation of Peripheral Pulmonary Lesions.

Abstract

Background: Electromagnetic navigation bronchoscopy (ENB) is an established modality for performing bronchoscopic biopsies of peripheral pulmonary lesions (PPLs). Although prior versions have been limited by computed tomography (CT) to body divergence (CTBD), the advent of digital fluoroscopic tomosynthesis with continuous real-time guidance with the Illumisite system may help to overcome CTBD. This enhanced visualization, however, will require additional radiation exposure to perform the 50-degree fluoroscopic sweep around the PPL, but data are lacking on the additional amount. The primary objective of our study is to evaluate the effective dose patients are exposed to during biopsy with this system.

Methods: Single center retrospective analysis evaluating demographic data, nodule size, nodule location, diagnostic yield, incidence of complications, and radiation exposure.

Results: Eighty-two patients underwent PPL biopsy from March 2021 to March 2023. The mean PPL size was 2.3±0.9 cm (0.9 to 4.9 cm) and 84% (n=69) were solid. The majority were in the peripheral lung third (53, 64.6%) and 71% (n=58) had an air bronchogram on CT chest. The mean fluoroscopy time was 5 minutes 10 seconds (± 3 min 39 s). The mean fluoroscopy cumulative air kerma (CAK) was 0.071 Gy (± 0.045 Gy) with a calculated mean effective dose of 0.997 mSv (± 0.63 mSv). The diagnostic yield was 73% (60/82). Pneumothorax occurred in 4 (5%) patients, all of which required chest tube drainage.

Conclusion: Radiation exposure with the Illumisite system was less than historical reports for CT-guided biopsy or cone beam CT-guided bronchoscopic biopsies. Diagnostic yield and incidence of complications were comparable to prior reports.