title: Percutaneous transthoracic localization of pulmonary nodules under C-arm cone-beam CT virtual navigation guidance.
abstract: OBJECTIVE
  We aimed to describe our initial experience with percutaneous transthoracic localization (PTL) of pulmonary nodules using a C-arm cone-beam CT (CBCT) virtual navigation guidance system.
  
  
  METHODS
  From February 2013 to March 2014, 79 consecutive patients (mean age, 61±10 years) with 81 solid or ground-glass nodules (mean size, 12.36±7.21 mm; range, 4.8-25 mm) underwent PTLs prior to video-assisted thoracoscopic surgery (VATS) excision under CBCT virtual navigation guidance using lipiodol (mean volume, 0.18±0.04 mL). Their procedural details, radiation dose, and complication rates were described.
  
  
  RESULTS
  All 81 target nodules were successfully localized within 10 mm (mean distance, 2.54±3.24 mm) from the lipiodol markings. Mean number of CT acquisitions was 3.2±0.7, total procedure time was 14.6±5.14 min, and estimated radiation exposure during the localization was 5.21±2.51 mSv. Postprocedural complications occurred in 14 cases (17.3%); complications were minimal pneumothorax (n=10, 12.3%), parenchymal hemorrhage (n=3, 3.7%), and a small amount of hemoptysis (n=1, 1.2%). All target nodules were completely resected; pathologic diagnosis included invasive adenocarcinoma (n=53), adenocarcinoma-in-situ (n=10), atypical adenomatous hyperplasia (n=4), metastasis (n=7), and benign lesions (n=7).
  
  
  CONCLUSIONS
  PTL procedures can be performed safely and accurately under the guidance of a CBCT virtual navigation system.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea. cmpark.morphius@gmail.com.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.forename: Chang Min
authors.initials: CM
authors.lastname: Park
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Lee
authors.forename: H Page
authors.initials: HP
authors.lastname: McAdams
authors.forename: Young Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Goo
mesh_terms: D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000601:surgery*; D015641:Radiography, Interventional / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods