{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:19:23Z","timestamp":1789517963304,"version":"build-2803163510"},"reference-count":43,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T00:00:00Z","timestamp":1732320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning. Methods: We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pneumothorax. Variations in patient positioning (prone, supine, lateral, lesion in decubitus biopsy-side-down [LD BSD] and the dependent area [L DA M], and access route beginning in the dependent area [AR LD M]) were compared using the chi-square, Fisher\u2019s exact, and Mann\u2013Whitney U tests. Performance metrics were evaluated. Univariate and binomial logistic regression models assessed the influence of these factors and other patient-related and interventional parameters on pneumothorax occurrence. Results: Three positional variants (AR DA M, L DA M, and L LD BSD; p &lt; 0.001), general emphysema (p = 0.009), emphysema in the access route (p = 0.025), greater needle size (18G vs. 20G; p &lt; 0.001), and the use of a side-cut instead of a full-core system (p = 0.002) were significantly linked to lower peri-interventional pneumothorax incidence. Even after adjusting for various factors, AR DA M and general emphysema remained independently associated with a reduced pneumothorax risk (OR 0.168, p &lt; 0.001; OR 2.72, p = 0.034). Assessing the dependent zones showed superior performance regardless of the patient\u2019s position, with the best performance demonstrated for AR DA M (AUC 0.705; sensitivity 60%, specificity 81.8%). Conclusions: Focusing on the dependent zones of each lung and adjusting the access route accordingly can significantly reduce the risk of pneumothorax compared to conventional positioning techniques.<\/jats:p>","DOI":"10.3390\/diagnostics14232639","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T05:21:32Z","timestamp":1732512092000},"page":"2639","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Enhanced Positioning Strategies to Reduce Pneumothorax in CT-Guided Lung Biopsies"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0552-4850","authenticated-orcid":false,"given":"Michael P.","family":"Br\u00f6nnimann","sequence":"first","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"},{"name":"Department of Radiology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Manser","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin H.","family":"Maurer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Oldenburg University Hospital, Carl von Ossietzky University of Oldenburg, 26129 Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9948-7220","authenticated-orcid":false,"given":"Bernhard","family":"Gebauer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5763-689X","authenticated-orcid":false,"given":"Timo A.","family":"Auer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Clinician Scientist Program, Berlin Institute of Health, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Schnapauff","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5378-461X","authenticated-orcid":false,"given":"Federico","family":"Collettini","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Clinician Scientist Program, Berlin Institute of Health, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh-Long","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alois","family":"Komarek","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miltiadis E.","family":"Krokidis","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"},{"name":"1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 15772 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes T.","family":"Heverhagen","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ccm.2012.11.001","article-title":"The evaluation and clinical application of pleural physiology","volume":"34","author":"Akulian","year":"2013","journal-title":"Clin. 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