Transbronchial biopsy of peripheral lung lesions using fluoroscopic guidance combined with an enhanced ray-summation display

  • Shogo SuzukiEmail author
  • Katsuhiro Ichikawa
  • Yasuhisa Kouno
  • Naoya Takeda
  • Yoshihiro Suzuki
  • Ayumi Suzuki


The aim of this study was to investigate the effectiveness of guidance assistance during transbronchial biopsy (TBB) to achieve an appropriate pathway to small and peripheral pulmonary lesions (PPLs) using a combination of fluoroscopy and specialized ray-summation (Ray-sumTBB) images, which were processed from preprocedural lung computed tomography (CT) images. To improve the visibility of the correct pathway to the PPLs, three-dimensional spatial resolution enhancement and CT number conversion processes were applied to the original CT images. The Ray-sumTBB images reconstructed from the processed CT images were used as additional guides. We compared the rates of successful tumor localization and biopsy (arrival rate) between the trial (with Ray-sumTBB) and control (without Ray-sumTBB) groups. The fluoroscopy and examination times were also compared. The arrival rate of the trial group (73.1%) was significantly better than that of the control group (42.3%) (p = 0.048). The fluoroscopy and examination times did not differ significantly between the trial and control groups. No complications were identified in the trial group. Our results suggest that Ray-sumTBB improves the diagnostic accuracy of TBB.


Transbronchial biopsy Ray-summation Frequency processing Peripheral pulmonary lesion Ground-glass opacity Endobronchial ultrasound 


Compliance with ethical standards

Conflict of interest

None of the authors has any conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board (IRB) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

Informed consent

Informed consent was obtained from all study participants.


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Copyright information

© Japanese Society of Radiological Technology and Japan Society of Medical Physics 2019

Authors and Affiliations

  1. 1.Department of Radiological TechnologyKariya Toyota General HospitalKariyaJapan
  2. 2.Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
  3. 3.Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
  4. 4.Department of Respiratory and Allergy MedicineKariya Toyota General HospitalKariyaJapan
  5. 5.Department of Thoracic SurgeryKariya Toyota General HospitalKariyaJapan

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