{
  "abstract": "Computed tomography (CT)-to-body divergence and tool-tissue divergence (TTD) limit bronchoscopic access to peripheral pulmonary lesions (PPLs). Fixed cone-beam CT (CBCT) with augmented fluoroscopy (AF) enables intraprocedural target segmentation, live fluoroscopic overlay, and confirmation of tool position. We describe three CBCT AF-guided spatial targeting techniques as a targeting workflow and compare manual pre-curved and shape-sensing robotic catheters using center strike as the primary technical endpoint. This retrospective single-center study included 200 consecutive patients with 219 biopsied PPLs. The first 100 patients underwent biopsy with manual pre-curved catheters (Medtronic; 106 lesions), followed by 100 patients who underwent biopsy using a shape-sensing robotic catheter (Intuitive; 113 lesions). All procedures used fixed CBCT-AF, a ventilation protocol with apneic breath-holding, needle targeting with traditional two-angle, slow-sweep, and/or center-datum techniques, and CBCT tool-position confirmation. Center strike was defined as needle position in the middle third of the lesion on axial, sagittal, and coronal CBCT images. The primary outcome was center-strike tool position; diagnostic yield and 1-year diagnostic accuracy were secondary outcomes. Robotic catheters achieved a higher center-strike rate, the primary endpoint, than manual catheters {66% [75/113; 95% confidence interval (CI): 57-74%] vs. 42% (45/106; 95% CI: 33-52%), P<0.001}, as well as a higher tool-in-lesion (TIL) rate [100% (113/113; 95% CI: 97-100%) vs. 91% (96/106; 95% CI: 83-95%), P<0.001]. Diagnostic yield was 91% (95% CI: 84-95%) vs. 80% (95% CI: 72-87%) (P=0.02), and 1-year diagnostic accuracy was 96% (95% CI: 91-99%) vs. 86% (95% CI: 78-91%) (P=0.01). Dose-area product (DAP) was higher with robotic catheters [median 13,251 [interquartile range (IQR), 8,683-18,264] vs. 11,114 (IQR, 6,336-15,199) µGy·m2, P=0.04], without significant differences in fluoroscopy time or number of CBCT spins. Two pneumothoraces occurred in the robotic cohort, one requiring chest tube placement. A CBCT AF-guided targeting workflow combines real-time needle-vector alignment with intraprocedural confirmation of tool position before tissue sampling. Within this workflow, robotic catheters achieved higher center-strike and TIL rates and were associated with improved diagnostic performance. Reliable intraprocedural spatial confirmation may become increasingly important as bronchoscopy evolves toward precision transbronchial therapies.",
  "abstract_shown": true,
  "affiliations": [
    "Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.",
    "Interventional Pulmonology, Inova Health System, Inova Fairfax Hospital, Falls Church, VA, USA.",
    "Section of Pulmonary and Critical Care Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Krish Bhadra",
      "orcid": "0009-0008-6410-5043"
    },
    {
      "affs": [
        0
      ],
      "name": "Pranjal Patel"
    },
    {
      "affs": [
        1
      ],
      "name": "Amit K Mahajan"
    },
    {
      "affs": [
        2
      ],
      "name": "D Kyle Hogarth"
    },
    {
      "affs": [
        2
      ],
      "name": "Ajay A Wagh"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/chsa4cfmd4knh.bib",
  "cited_by": 0,
  "doi": "10.21037/jtd-2026-2065",
  "fulltext_url": "https://europepmc.org/articles/PMC13740703",
  "id": "chsa4cfmd4knh",
  "issns": [
    "2072-1439",
    "2077-6624"
  ],
  "landing_url": "https://europepmc.org/article/MED/42996643",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Lung Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7223301763",
  "pdf_url": "https://europepmc.org/articles/PMC13740703?pdf=render",
  "pmcid": "PMC13740703",
  "pmid": "42996643",
  "published": "2026-09-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/chsa4cfmd4knh.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42996643",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42996643"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Lung Cancer Diagnosis and Treatment",
      "subfield": "general"
    }
  ],
  "title": "Cone-beam computed tomography augmented-fluoroscopy-guided center-strike targeting during peripheral bronchoscopy: robotic vs. manual catheters.",
  "title_text": "Cone-beam computed tomography augmented-fluoroscopy-guided center-strike targeting during peripheral bronchoscopy: robotic vs. manual catheters.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/chsa4cfmd4knh",
  "venue": "Journal of thoracic disease",
  "versions": []
}