{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:40:03Z","timestamp":1784032803044,"version":"3.55.0"},"reference-count":23,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pneumothorax (PTX) is the most common complication of CT-guided lung biopsies. New technical advances, namely the optimization of needle approach angles within an a priori defined \u201csafe zone,\u201d are intended to reduce this risk. This study evaluates whether PTX incidence and chest tube placement decreased significantly after these technical advances were implemented. Methods: We retrospectively analyzed 118 consecutive patients who had undergone CT-guided lung biopsy between 9 January 2020, and 4 April 2025. The study was divided into three periods of increasingly growing institutional procedural experience: Pre-Knowledge (January 2020\u2013March 2022; n = 45), Partial Knowledge (April\u2013December 2022; n = 18), and Full Knowledge (January 2023\u2013April 2025; n = 55). PTX incidence and chest tube use were compared across periods using chi-square and Fisher\u2019s exact tests, while Kaplan\u2013Meier survival analysis was used to evaluate PTX-free survival over time. Results: Overall PTX incidence significantly declined from 71.1% in the Pre-Knowledge Period to 21.8% in the Full Knowledge Period (p &lt; 0.000001). Rates of chest tube placements also decreased from 17.8% to 9.1%, although this difference was not statistically significant (p = 0.372). Kaplan\u2013Meier analysis showed a statistically significant improvement in PTX-free survival over time (indicating improvement in the timing of complication onset; p = 0.0042). Procedural optimization was also fostered by a large median intrapulmonary needle length and consistent needle angulation within the safe zone. Conclusions: Formal implementation of needle angle optimization and procedural protocol standardization has effectively reduced the frequency and severity of PTX following CT-guided lung biopsies. These results highlight the benefit of continuous education and technique standardization in improving patient safety and clinical outcomes.<\/jats:p>","DOI":"10.3390\/jcm14144838","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T09:12:48Z","timestamp":1751965968000},"page":"4838","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Technical Standardization on Pneumothorax and Chest Tube Insertion Rates: A Retrospective Learning Curve Analysis of CT-Guided Lung Biopsies"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5108-2104","authenticated-orcid":false,"given":"Rosa Alba","family":"Pugliesi","sequence":"first","affiliation":[{"name":"Section of Radiology\u2014Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Younesse","family":"Nasser","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Benchekroun","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roua","family":"BenAyed","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas H.","family":"Mahnken","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4547-4229","authenticated-orcid":false,"given":"Nour","family":"Maalouf","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, T\u03cbbingen University Hospital, 72076 T\u03cbbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Apitzsch","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Saggiante, L., Biondetti, P., Lanza, C., Carriero, S., Ascenti, V., Piacentino, F., Shehab, A., Ierardi, A.M., Venturini, M., and Carrafiello, G. 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