Establishing a Cone Beam CT-Guided Bronchoscopy Program: A Stepwise Guide for Interventional Pulmonologists

Cone beam computed tomography (CBCT)-guided bronchoscopy has emerged as a powerful tool in the diagnosis of peripheral lung lesions, offering real-time, image-confirmed biopsy capabilities that enhance precision and diagnostic yield. However, implementation of a CBCT program presents significant logistical and technical challenges. This article presents an experience-based implementation tutorial outlining a stepwise approach to establishing a CBCT-guided bronchoscopy program. The framework is derived from iterative workflow development across more than 300 procedures at our institution, St. Elisabethen Hospital in Frankfurt, Germany, as well as our implementation efforts at Avenue Hospital Parklands in Nairobi, Kenya. Key domains addressed include infrastructure assessment, access strategy, training, procedural logistics, ventilation protocols, case selection, workflow optimization, safety considerations, and business case development. This roadmap aims to support interventional pulmonologists in integrating CBCT into clinical practice, while emphasising the need for local adaptation based on institutional resources and multidisciplinary collaboration.