{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:44:22Z","timestamp":1793137462434,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objective<\/jats:title><jats:p>As the presentation of pulmonary nodules increases, the importance of a safe and accurate method of sampling peripheral pulmonary nodules is highlighted. First\u2010generation robotic bronchoscopy has successfully assisted navigation and improved peripheral reach during bronchoscopy. Integrating tool\u2010in\u2010lesion tomosynthesis (TiLT) may further improve yield.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a first\u2010in\u2010human clinical trial of a new robotic electromagnetic navigation bronchoscopy system with integrated digital tomosynthesis technology (Galaxy System, Noah Medical). Patients with moderate\u2010risk peripheral pulmonary nodules were enrolled in the study. Robotic bronchoscopy was performed using electromagnetic navigation with TiLT\u2010assisted lesion guidance. Non\u2010specific results were followed up until either a clear diagnosis was achieved or repeat radiology at 6\u2009months demonstrated stability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighteen patients (19 nodules) were enrolled. The average lesion size was 20\u2009mm, and the average distance from the pleura was 11.6\u2009mm. The target was successfully reached in 100% of nodules, and the biopsy tool was visualized inside the target lesion in all cases. A confirmed specific diagnosis was achieved in 17 nodules, 13 of which were malignant. In one patient, radiological monitoring confirmed a true non\u2010malignant result. This translates to a yield of 89.5% (strict) to 94.7% (intermediate). Complications included one pneumothorax requiring observation only and another requiring an overnight chest drain. There was one case of severe pneumonia following the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this first\u2010in\u2010human study, second\u2010generation robotic bronchoscopy using electromagnetic navigation combined with integrated digital tomosynthesis was feasible with an acceptable safety profile and demonstrated a high diagnostic yield for small peripheral lung nodules.<\/jats:p><jats:p><jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp14778-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.14778","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T09:04:38Z","timestamp":1719219878000},"page":"969-975","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["First\u2010in\u2010human use of a new robotic electromagnetic navigation bronchoscopic platform with integrated Tool\u2010in\u2010Lesion Tomosynthesis (<scp>TiLT<\/scp>) technology for peripheral pulmonary lesions: The <scp>FRONTIER<\/scp> study"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1431-8724","authenticated-orcid":false,"given":"Tajalli","family":"Saghaie","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4957-3961","authenticated-orcid":false,"given":"Jonathan P.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6526-6318","authenticated-orcid":false,"given":"Martin","family":"Phillips","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dona","family":"Kafili","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarika","family":"Sundar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kyle","family":"Hogarth","sequence":"additional","affiliation":[{"name":"University of Chicago Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-020X","authenticated-orcid":false,"given":"Alvin","family":"Ing","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Health and Human Sciences Macquarie University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2015.09.009"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2022.09.005"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1102\/1470-7330.2011.9020"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10235678"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000687"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2020.03.85"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2020.01.35"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-216492"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017170893"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2017.08.18"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-019-0857-z"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/LBR.0000000000000923"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.08.074"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202401-0192ST"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-13-9905-3"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201507-1332OC"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3747\/co.19.1062"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2020-abpd-003"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-023-00596-9"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.107.2.430"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-76998-z"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.08.2047"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-019-1010-8"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000002304"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2462070712"}],"container-title":["Respirology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/resp.14778","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T01:11:37Z","timestamp":1729213897000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/resp.14778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,24]]},"references-count":26,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1111\/resp.14778"],"URL":"https:\/\/doi.org\/10.1111\/resp.14778","archive":["Portico"],"relation":{},"ISSN":["1323-7799","1440-1843"],"issn-type":[{"value":"1323-7799","type":"print"},{"value":"1440-1843","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,24]]},"assertion":[{"value":"2024-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}