PMC9343982_01
The CIOS three-dimensional (3D) Spin Mobile (Siemens Medical Solutions, Malvern, PA, USA) offers a compact, mobile 3D planar image modality that complements robotic bronchoscopic biopsy. The lateral position leaves the head clear for anesthesia and robotic equipment.
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The lesion of interest was placed in the center of the c-arm by adjusting the table and/or c-arm position using lasers from the c-arm (Figure 3, Video 1).
Computed tomography scan demonstrating a 2.1-cm mass in the right lower lobe that was hypermetabolic on a subsequent positron emission tomography scan.
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While the patient was asymptomatic, a routine CT scan for cancer surveillance demonstrated an incidentally found 2.1-cm solid nodule in the right lower lobe that was hypermetabolic on subsequent positron emission tomography (PET) imaging, suspicious for metastasis versus primary lung cancer (Figure 2).
The anatomy of interest is set to the isocenter of the c-arm by aligning the lasers with the final alignment confirmed using a short fluoroscopic pulse. The anteroposterior and lateral planes are of the c-arms are visualized with the crosshairs denoting the approximately nodule location.
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The lesion of interest was placed in the center of the c-arm by adjusting the table and/or c-arm position using lasers from the c-arm (Figure 3, Video 1).
The lesion of interest is set to the isocenter of the c-arm by adjusting the table and/or c-arm position.
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The CIOS was rotated 90  left anterior oblique to 90  right anterior oblique to ensure clearance of all equipment (Figure 4).
Rotation of the CIOS which ensures clearance of the anesthesia circuit, access, lines and other equipment. The proceduralist has unobstructed access to the patient's head.
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A 30 second intraoperative CBCT scan with an inspiratory hold at 20 cmH2O visualized the catheter tip relative to the target nodule (Video 2, Figure 5).
A 30-second intraoperative mobile imaging scan visualized the catheter tip relative to the target nodule.
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Re-registration and re-navigation showed tool-in-lesion on repeat spin with radial endobronchial ultrasound (EBUS) confirming proximity to the lesion (Figure 6).