J Cancer 2014; 5(3):192-202. doi:10.7150/jca.8395 This issue

Research Paper

Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation - A Phantom Study

Wolfgang Hohenforst-Schmidt1, Rosemarie Banckwitz2, Paul Zarogoulidis3,4✉, Thomas Vogl5, Kaid Darwiche4, Eugene Goldberg6, Haidong Huang7,8, Michael Simoff8, Qiang Li7, Robert Browning9, Lutz Freitag4, J Francis Turner10, Patrick Le Pivert11, Lonny Yarmus12, Konstantinos Zarogoulidis3, Johannes Brachmann1

1. II Medical Clinic, Coburg Hospital, University of Wuerzburg, Coburg, Germany;
2. Siemens AG Healthcare Sector, Forchheim, Germany;
3. Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece;
4. Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany;
5. Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany;
6. Biomaterials Science and Engineering, Department of Materials Science and Engineering, University of Florida, FL, USA;
7. Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People's Republic of China;
8. Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, MI, USA;
9. Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA;
10. Pulmonary Medicine, University of Nevada School of Medicine, National Supercomputing Center for Energy and the Environment University of Nevada, Las Vegas, NV, USA;
11. Interventional Drug Delivery Systems and Strategies (ID2S2), Medical Cryogenics, Jupiter, FL, USA;
12. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Johns Hopkins University, Baltimore, U.S.A.

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Hohenforst-Schmidt W, Banckwitz R, Zarogoulidis P, Vogl T, Darwiche K, Goldberg E, Huang H, Simoff M, Li Q, Browning R, Freitag L, Turner JF, Pivert PL, Yarmus L, Zarogoulidis K, Brachmann J. Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation - A Phantom Study. J Cancer 2014; 5(3):192-202. doi:10.7150/jca.8395. Available from https://www.jcancer.org/v05p0192.htm

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Rationale: Cone Beam Computed Tomography imaging has become increasingly important in many fields of interventional therapies. Objective: Lung navigation study which is an uncommon soft tissue approach. Methods: As no effective organ radiation dose levels were available for this kind of Cone Beam Computed Tomography application we simulated in our DynaCT (Siemens AG, Forchheim, Germany) suite 2 measurements including 3D acquisition and again for 3D acquisition and 4 endobronchial navigation maneuvers under fluoroscopy towards a nodule after the 8th segmentation in the right upper lobe over a total period of 20 minutes (min). These figures reflect the average complexity and time in our experience. We hereby describe the first time the exact protocol of lung navigation by a Cone Beam Computed Tomography approach. Measurement: The hereby first time measured body radiation doses in that approach showed very promising numbers between 0,98-1,15mSv giving specific lung radiation doses of 0,42-0,38 mSv. Main results: These figures are comparable or even better to other lung navigation systems. Cone Beam Computed Tomography offers some unique features for lung interventionists as a realtime 1-step navigation system in an open structure feasible for endobronchial and transcutaneous approach. Conclusions: Due to this low level of radiation exposure Cone Beam Computed Tomography is expected to attract interventionists interested in using and guiding endobronchial or transcutaneous ablative procedures to peripheral endobronchial and other lung lesions.

Keywords: Dyna CT, lung cancer, diagnosis.