Portable Cone-Beam Computed Tomography System for Intraoperative Localization of Pulmonary Nodules - Initial Experience

Sep 30, 2026

Advances in imaging have broadened diagnostic and therapeutic options, including wedge resection for small pulmonary nodules. Cone-beam computed tomography (CBCT) can replace hybrid operating rooms to identify impalpable nodules. This report presents an initial clinical use of a portable CBCT system (Cios Spin) to localize small pulmonary nodules during surgery. Four patients with peripheral nodules underwent thoracoscopic marking using preoperative CT guidance.

LanguageEnglish

CategoryHealthcare

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Abstract

Objectives

Methods

Results

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Introduction

Materials and Methods

Interdisciplinary CardioVascular and Thoracic Surgery 2026, 41(1), ivaf314 BRIEF COMMUNICATIONS [https://doi.org/10.1093/icvts/ivaf314](https://doi.org/10.1093/icvts/ivaf314) Advance Access publication 30 December 2025 Cite this article as: Mitsuoka M, Mitsuoka N, Ueta Y, Uchida Y, Hashiguchi T, Yokoyama S et al. Portable Cone-Beam Computed Tomography System for Intraoperative Localization of Pulmonary Nodules: An Initial Experience. Interdiscip CardioVasc Thorac Surg 2026; doi:10.1093/icvts/ivaf314. Portable Cone-Beam Computed Tomography System for Intraoperative Localization of Pulmonary Nodules: An Initial Experience Masahiro Mitsuoka 􀀃 ; Nagiko Mitsuoka; Yuichiro Ueta; Yusuke Uchida; Toshihiro Hashiguchi; Shintaro Yokoyama; Masaki Kashihara ; Yasuhiro Terazaki Department of Surgery, Kurume University School of Medicine, Fukuoka, 830-0011, Japan 􀀃 Corresponding author. Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan (mitsuoka_masahiro@ [kurume-u.ac.jp](kurume-u.ac.jp)). Received: August 28, 2025; Revised: October 20, 2025; Accepted: December 14, 2025 Abstract Objectives: Advances in imaging have expanded options for diagnosis and therapy, including wedge resection of small pulmonary nodules. Cone-beam computed tomography (CBCT) can substitute for hybrid operating rooms (ORs) to identify impalpable nodules. We report the initial clinical use of a portable CBCT system (Cios Spin, Siemens, Germany) for intraoperative localization of small pulmonary nodules. Methods: Four patients (3 men, 1 woman; mean age, 68.3 years) with peripheral nodules were included. Under general anaesthesia, an initial pre-scan confirmed that the lesion was within the field of view. Thoracoscopic surgery was initiated, and a surgical clip was placedon the visceral pleura at the site predicted from preoperative computed tomography (CT) to be closest to the tumour. During surgery, the C-arm was removed and later repositioned for intraoperative scanning. Results: All nodules, 1.4-cm ground-glass, 2.0-cm part-solid, and two 0.7-cm, were clearly visualized, with image quality comparable topreoperative CT. The portable system accommodated table flexion and lateral decubitus positioning. No complications occurred, and radiation exposure, measured in one case, was acceptable. Conclusions: To our knowledge, this is the first report to demonstrate that portable CBCT enables accurate, flexible, and real-time intraoperative localization of pulmonary nodules without requiring a hybrid OR. Keywords: cone-beam computed tomography (CBCT) • portable imaging • early-stage lung cancer • ground-glass nodules • metastatic pulmonary tumour • wedge resection INTRODUCTION The intraoperative localization of small pulmonary nodules remains a challenge in general thoracic surgery, especially in wedge resection of the lungs. Recently, cone-beam computed tomography (CBCT) has been proven effective in hybrid operating rooms (ORs).1–3 However, this procedure has been used only in hybrid ORs, where patient-positioning options are limited. In this report, we describe our initial experience with portable CBCT, in which small nodules were clearly visualized using this previously reported technique in thoracic surgery,2 and we assess whether positioning flexibility can be improved. MATERIALS AND METHODS This retrospective case series describes our initial clinical experience using a portable CBCT system for intraoperative lung Meeting presentation: This study was presented at the World Conference on Lung Cancer, San Diego, United States, September 2024. nodule localization. All procedures were part of routine intraoperative lung nodule marking conducted under Institutional Review Board (IRB) oversight, with written informed consent obtained from all patients prior to surgery. This study was approved by the IRB of Kurume University Hospital (approval number: 20008). Four patients (3 men

FAQs

What is the purpose of the portable CBCT system in this study?

The study evaluates portable CBCT for intraoperative localization of small pulmonary nodules, aiming to support accurate real-time marking without requiring a hybrid operating room.

How were the patients and nodules selected?

Four patients with peripheral pulmonary nodules (0.7–2.0 cm) were included. The nodules were suspected to be malignant and predicted to be non-palpable.

What procedure did the team use during surgery for localization?

Under general anaesthesia, a pre-scan confirmed the lesion within the CBCT field of view. A predicted closest site was marked using surgical clips on the visceral pleura, with intraoperative scanning after repositioning the C-arm.

Sep 30, 2026

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