Abstract Rationale Robotic-assisted bronchoscopy (RAB) enhances diagnostic precision for peripheral pulmonary lesions (PPLs) through improved navigation, reach, and stability. The Ion Endoluminal System employs shape-sensing (SS) technology and typically requires perioperative cone-beam CT (CBCT) imaging to confirm tool-to-lesion positioning and compensate for CT-to-body divergence. In contrast, the Galaxy System integrates electromagnetic navigation bronchoscopy (ENB) with digital tomosynthesis (DT) and augmented fluoroscopy (AF) and is compatible with CBCT providing dynamic intraprocedural lesion updates without requiring CBCT. Both platforms have demonstrated high diagnostic yield. This study compared clinical outcomes and radiation exposure between these two systems in consecutive patient cohorts at a single institution. Methods This retrospective, single-center study analyzed 20 consecutive patients who underwent ssRAB using the Ion System with CBCT and 20 patients who underwent DT-corrected ENB and CBCT using the Galaxy System. All procedures were performed by the same operators under a standardized lung navigation ventilation protocol. Collected data included demographics, lesion size and location, fluoroscopy time, CBCT spins, total radiation dose, procedure duration, and diagnostic yield (according to the ATS/ACCP strict definition). Statistical analyses used t-tests and Fisher’s exact test, with p ≤ 0.05 considered significant. Results The two cohorts were demographically comparable (mean age 69.5 vs 68.7 years, 30% vs 45% female for Galaxy and Ion, respectively). The mean lesion size was 26.6 ± 18.3 mm (Galaxy) and 17.4 ± 10.7 mm (Ion). Mean procedure times were similar (76.4 ± 9.4 min vs 73.6 ± 16.2 min, p = 0.50), as were fluoroscopy times (635 ± 190 sec vs 545 ± 229 sec, p = 0.19). Radiation exposure was significantly lower with Galaxy (6,281 ± 3,877 μGy·m²) compared to Ion (10,603 ± 6,554 μGy·m², p = 0.015). Galaxy required fewer CBCT spins (1.1 ± 0.3 vs 2.6 ± 0.9, p 0.0001). Diagnostic yield per strict definition was 85% with Galaxy versus 70% with Ion. No major procedural complications occurred in either cohort. Conclusions The Galaxy System was significantly lower radiation exposure when incorporating DT and AF compared to the Ion System, while maintaining similar procedural efficiency and safety. Integration of DT and AF into RAB workflows may reduce radiation exposure. A larger, multi-center prospective study is warranted to validate these findings. This abstract is funded by: None
K Bhadra (Fri,) studied this question.