Effect of Rapid Rollover on Pneumothorax After CT-Guided Lung Biopsy

All patients will undergo CT-guided lung biopsy by the best approach decided by the primary operator. Randomization will be performed based on parity of patients' medical record numbers, which were assigned randomly at their first presentation. Patients with even medical record numbers will be assigned to the control group and patients with odd medical record number will be assigned to the intervention group.

In the rapid rollover group, patients will be repositioned upon being transferred from the CT scanner table to the stretcher such that the biopsy site is down. Patient in the intervention arm will be maintained in the same position in the post-procedure recovery area for at least 2 hours if patients can tolerate. Anyone who maintains the biopsy-site down position for at least 30 minutes after repositioning in the intervention group will be considered as completion of the intervention. Patients who are in the controlled arm may choose the most comfortable position per their preferences. All patients will be monitored for at least 2 hours, after which a 0-1 hour optional post-biopsy radiograph and 2-hour follow-up radiograph will be obtained to assess for pneumothorax per the standard current protocol. Further follow-up radiograph may be obtained if the patient did not receive the 0-1 hour radiograph and the 2-hour radiograph was positive for pneumothorax that is not large enough to require immediate chest tube insertion. Interpreting radiologists of the post-biopsy radiographs will be blinded to whether the patient is in the control or intervention group.

A survey will be given to the patients in post-anesthesia care unit by nurses before they are discharged.

Multiple patient-, lesion- and technique-specific factors will be recorded:

Patient-specific factors:

Age
Gender
Indication of lung biopsy
History of underlying lung disease
History of tobacco use
Prior lung surgery or radiation

Lesion-specific factors:

Location
Size
Morphology
Shortest distance from pleura Technique-specific factors
Approach
Patient positioning during procedure
Number of times crossing the pleura
Number of times crossing the fissure
Number of fine needle aspirations (FNAs)
Number of core biopsies
Needle-path length
Needle-pleura angle
Co-axial size
Duration of biopsy site down time and number of turns as tolerated by the patient
Use of blood patch