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Identifying high-risk patients can prompt alternative biopsy modes and\/or better preparation for more focused post-procedural care. We aimed to develop and externally validate a risk nomogram for pneumothorax requiring chest tube placement following CT-guided lung biopsy, leveraging quantitative emphysema algorithm.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This two-center retrospective study included patients who underwent CT-guided lung biopsy from between 1994 and 2023. Data from one hospital was set aside for validation (n\u2009=\u2009613). Emphysema severity was quantified and categorized to 3-point scale using a previously published algorithm based on 3\u00d73\u00d73 kernels and Hounsfield thresholding, and a risk calculator was developed using forward variable selection and logistic regression. The model was validated using bootstrapping and Harrell\u2019s C-index.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>2,512 patients (mean age, 64.47\u00a0years\u2009\u00b1 13.38 [standard deviation]; 1250 men) were evaluated, of whom 157 (6.7%) experienced pneumothorax complications requiring chest tube placement. After forward variable selection to reduce the covariates to maximize clinical usability, the risk score was developed using age over 60 (OR 1.80 [1.15\u20132.93]), non-prone patient position (OR 2.48 [1.63\u20133.75]), and severe emphysema (OR 1.99 [1.35\u20132.94]). The nomogram showed a mean absolute error of 0.5% in calibration and Harrell\u2019s C-index of 0.664 in discrimination in the internal cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The developed nomogram predicts age over 60, non-prone position during biopsy, and severe emphysema to be most predictive of pneumothorax requiring chest tube placement following CT-guided lung biopsy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12880-025-01794-y","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T09:10:44Z","timestamp":1751361044000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a risk nomogram predicting pneumothorax requiring chest tube placement post-percutaneous CT-guided lung biopsy"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3471-7095","authenticated-orcid":false,"given":"Masha","family":"Bondarenko","sequence":"first","affiliation":[]},{"given":"Jianxiang","family":"Zhang","sequence":"additional","affiliation":[]},{"suffix":"Jr","given":"Ulysis Hugo","family":"Baal","sequence":"additional","affiliation":[]},{"given":"Brian","family":"Lam","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2872-3828","authenticated-orcid":false,"given":"Gunvant","family":"Chaudhari","sequence":"additional","affiliation":[]},{"given":"Yoo Jin","family":"Lee","sequence":"additional","affiliation":[]},{"given":"Jamie","family":"Schroeder","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4816-5563","authenticated-orcid":false,"given":"Maya","family":"Vella","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9409-9213","authenticated-orcid":false,"given":"Brian","family":"Haas","sequence":"additional","affiliation":[]},{"given":"Thienkhai","family":"Vu","sequence":"additional","affiliation":[]},{"given":"Kimberly","family":"Kallianos","sequence":"additional","affiliation":[]},{"given":"Jonathan","family":"Liu","sequence":"additional","affiliation":[]},{"given":"Shravan","family":"Sridhar","sequence":"additional","affiliation":[]},{"given":"Brett","family":"Elicker","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6733-7551","authenticated-orcid":false,"given":"Jae Ho","family":"Sohn","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"1794_CR1","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.ejrad.2006.02.001","volume":"59","author":"N Tomiyama","year":"2006","unstructured":"Tomiyama N, Yasuhara Y, Nakajima Y, et al. 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