A New Approach to Manual CT Scan Reading for Planning the Pathway to Peripheral Pulmonary Lesions

Background: Accurate navigation to peripheral pulmonary lesions through bronchoscopy is crucial for lung cancer diagnosis. Manual pathway planning using CT scans can be effective but is often hindered by a steep learning curve and cognitive complexity. Simplifying this process could make manual planning more accessible and reliable, especially when other systems like virtual bronchoscopy (VB) are unavailable or have limitations.In this study, we aimed to evaluate the effectiveness of a simplified manual planning method using multiplanar reconstruction (MPR) compared with VB system for pathway planning to peripheral pulmonary lesions. Methods: A retrospective study of 51 CT scans from patients undergoing r-EBUS-guided bronchoscopy was conducted. Pathway planning was performed using VB system (Archimedes) and a simplified manual method leveraging MPR performed by 3 different operators. Concordance between methods and planning times were compared. Results: Pathway concordance was 78.5% (40/51 cases). The manual method identified additional bifurcations missed by VB in 7 cases and succeeded where VB failed in 3 cases. Mean planning times were 00:45±00:12 for VB and 01:30±00:44 for the manual method (P<0.0001). Conclusion: The simplified manual planning method demonstrated a high level of concordance with VB systems, while offering unique advantages in identifying additional bifurcations and resolving cases where VB systems were unsuccessful. Although the manual method required longer planning times, its cost-effectiveness and accessibility highlight its potential as a valuable alternative, particularly in resource-limited settings or as a tool to enhance bronchoscopists' spatial awareness and procedural confidence.