Background/Objectives:Although surgeries employing cone-beam computed tomography (CBCT) for small lung lesions have been reported, the association between CBCT scan frequency and patient radiation exposure remains unclear. This study aimed to investigate patient radiation doses from CBCT during thoracic surgeries, and the patient radiation doses were compared with those from other preoperative marking methods.Methods: This multicenter prospective study included 81 patients who underwent surgery for small lung lesions requiring marking between January 2021 and June 2024 at three institutions. CBCT-guided surgeries involved the use of metal clips in a hybrid operating room with 1–4 scans, depending on the lesion. For other preoperative marking methods, hook-wire or virtual-assisted lung mapping (VAL-MAP) was used. Patient radiation doses were measured using wearable dosimeters at five anterior thorax sites, and the total dose was compared across methods.Results: The study included 81 patients: CBCT (n= 61), VAL-MAP (n= 10), and hook-wire (n= 10). CBCT cases were distributed as follows: single scan (n= 10), double scans (n= 34), triple scans (n= 15), and quadruple scans (n= 2). The radiation doses were 86.9 ± 61.7 mGy for hook-wire, 39.8 ± 27.5 mGy for VAL-MAP, and 11.0 ± 6.5 mGy for single-scan CBCT, 17.3 ± 7.8 mGy for double scans, 23.1 ± 14.0 mGy for triple scans, and 22.7 ± 0.1 mGy for quadruple scans. Although radiation exposure increased with more CBCT scans, performing up to triple scans resulted in significantly lower exposure compared to other methods.Conclusions: Intraoperative CBCT is a feasible and safe technique for identifying small lung lesions, providing lower radiation exposure compared to other preoperative localization methods.
背景/目的：尽管已有应用锥形束计算机断层扫描（CBCT）进行肺部小结节手术的报道，但CBCT扫描次数与患者辐射暴露之间的关系尚不明确。本研究旨在探讨胸外科手术中CBCT对患者的辐射剂量，并将其与其他术前定位方法的辐射剂量进行比较。 方法：这项多中心前瞻性研究纳入了2021年1月至2024年6月期间在三个医疗中心接受手术、需进行术前定位的81例肺部小结节患者。CBCT引导手术在复合手术室中进行，根据病灶情况使用金属夹定位，扫描次数为1-4次。其他术前定位方法采用钩线定位或虚拟辅助肺图定位（VAL-MAP）。通过佩戴于胸前五个部位的剂量计测量患者辐射剂量，并比较不同方法的总辐射剂量。 结果：研究共纳入81例患者，其中CBCT组61例，VAL-MAP组10例，钩线定位组10例。CBCT组扫描次数分布为：单次扫描10例，双次扫描34例，三次扫描15例，四次扫描2例。辐射剂量分别为：钩线定位组86.9±61.7 mGy，VAL-MAP组39.8±27.5 mGy；CBCT组中单次扫描11.0±6.5 mGy，双次扫描17.3±7.8 mGy，三次扫描23.1±14.0 mGy，四次扫描22.7±0.1 mGy。虽然CBCT扫描次数增加会提高辐射暴露，但进行至三次扫描时的辐射剂量仍显著低于其他定位方法。 结论：术中CBCT是定位肺部小结节的可行且安全的技术，与其他术前定位方法相比，能够提供更低的辐射暴露。
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