Enhanced Positioning Strategies to Reduce Pneumothorax in CT-Guided Lung Biopsies
Michael P. Brönnimann,
Leonie Manser,
Martin H. Maurer,
Bernhard Gebauer,
Timo A. Auer,
Dirk Schnapauff,
Federico Collettini,
Thanh-Long Nguyen,
Alois Komarek,
Miltiadis E. Krokidis,
Johannes T. Heverhagen
Affiliations
Michael P. Brönnimann
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
Leonie Manser
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
Martin H. Maurer
Department of Diagnostic and Interventional Radiology, Oldenburg University Hospital, Carl von Ossietzky University of Oldenburg, 26129 Oldenburg, Germany
Bernhard Gebauer
Department of Radiology, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Timo A. Auer
Department of Radiology, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Dirk Schnapauff
Department of Radiology, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Federico Collettini
Department of Radiology, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Thanh-Long Nguyen
Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
Alois Komarek
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
Miltiadis E. Krokidis
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
Johannes T. Heverhagen
Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
Background/Objectives: This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning. Methods: We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pneumothorax. Variations in patient positioning (prone, supine, lateral, lesion in decubitus biopsy-side-down [LD BSD] and the dependent area [L DA M], and access route beginning in the dependent area [AR LD M]) were compared using the chi-square, Fisher’s exact, and Mann–Whitney U tests. Performance metrics were evaluated. Univariate and binomial logistic regression models assessed the influence of these factors and other patient-related and interventional parameters on pneumothorax occurrence. Results: Three positional variants (AR DA M, L DA M, and L LD BSD; p p = 0.009), emphysema in the access route (p = 0.025), greater needle size (18G vs. 20G; p p = 0.002) were significantly linked to lower peri-interventional pneumothorax incidence. Even after adjusting for various factors, AR DA M and general emphysema remained independently associated with a reduced pneumothorax risk (OR 0.168, p p = 0.034). Assessing the dependent zones showed superior performance regardless of the patient’s position, with the best performance demonstrated for AR DA M (AUC 0.705; sensitivity 60%, specificity 81.8%). Conclusions: Focusing on the dependent zones of each lung and adjusting the access route accordingly can significantly reduce the risk of pneumothorax compared to conventional positioning techniques.
