Percutaneous CT-guided approach is the standard of care for small lung tumor localization. But with certain tumor location(ex: lung apex, close to diaphragm or mediastinum, or located behind chest wall structures such as the scapula), it is very difficult and/or dangerous for percutaneous puncture. In such situation, accessing the lesion through the endobronchial route is the procedure of choice. Electromagnetic navigation bronchoscopy (ENB) has been widely adopted as a guidance technique for localizing of lung nodules with theoretically minimal or no radiation exposure.

However, one major limitation is that position of the catheter with respect to the lesion is projected onto CT images(performed preoperatively under full inspiration phase) and is thus virtual, rather than real-time. Movement of the lung occurs with respiratory variation during bronchoscopy, and the location of pulmonary nodules during procedures may differ significantly from their location on the initial planning full-inspiratory chest CT scan. The combination use of ENB and CBCT provided a better solution.

Intra-procedural CBCT imaging can be utilized to assess or confirm the location of catheter.This allows for accurate localization of the lesion as well as real-time confirmation. Additionally, this allows for non-fluoroscopically visible lesions to now be visible. Most importantly, 3D real-time imaging is able to overcome CT-to-body divergence issues that plague current forms of navigational bronchoscopy. As the field advances toward the possibility of bronchoscopic ablation of peripheral tumors, real-time confirmation of probe positioning will be imperative.