{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:53:17Z","timestamp":1782921197005,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background\/Objectives: To evaluate whether day-of-procedure ambient ozone exposure is associated with pneumothorax after CT-guided lung biopsy. Methods: This retrospective single-centre study included 160 CT-guided lung biopsies performed between January 2018 and February 2026. Environmental data from the day of biopsy were assigned from the nearest national monitoring station. The primary outcome was any pneumothorax on post-biopsy CT; the secondary outcome was drainage-requiring pneumothorax. Multivariable logistic regression included ozone exposure, emphysema, and access route through dependent lung area (ARDA). Ozone was analysed as a continuous variable per 10 \u03bcg\/m3 and, exploratorily, using a ROC-derived threshold of \u226575.8 \u03bcg\/m3. Restricted cubic splines assessed nonlinearity. Sensitivity models adjusted for needle size, biopsy system, operator identity, and season. Drainage-requiring pneumothorax was analysed using Firth logistic regression. Results: Pneumothorax occurred after 86 of 160 biopsies (53.8%), and 13 biopsies (8.1%) required drainage. Ozone was not associated with pneumothorax when modelled linearly (OR, 1.09 per 10 \u03bcg\/m3; 95% CI, 0.97\u20131.23; p = 0.167). In exploratory threshold modelling, ozone \u2265 75.8 \u03bcg\/m3 was associated with pneumothorax (OR, 2.76; 95% CI, 1.39\u20135.61; p = 0.004). Emphysema increased pneumothorax odds (OR, 2.16; 95% CI, 1.03\u20134.68; p = 0.047), whereas ARDA was protective (OR, 0.23; 95% CI, 0.11\u20130.45; p &lt; 0.001). Spline analysis supported nonlinearity (p = 0.001). For drainage-requiring pneumothorax, only emphysema was significant. Conclusions: Ambient ozone showed an exploratory nonlinear association with pneumothorax after CT-guided lung biopsy, with a threshold signal around 70\u201380 \u03bcg\/m3. ARDA was protective, whereas emphysema was associated with drainage-requiring pneumothorax.<\/jats:p>","DOI":"10.3390\/tomography12070098","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:41:38Z","timestamp":1782909698000},"page":"98","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ambient Ozone Exposure and Pneumothorax Risk After CT-Guided Lung Biopsy"],"prefix":"10.3390","volume":"12","author":[{"given":"Nour","family":"Afilal","sequence":"first","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Rosenb\u00fchlgasse 27, 3010 Bern, Switzerland"},{"name":"Service of Radiology, Geneva University Hospital, 1211 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7840-8153","authenticated-orcid":false,"given":"Alois","family":"Komarek","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Rosenb\u00fchlgasse 27, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8349-4813","authenticated-orcid":false,"given":"Michael","family":"Dieckmeyer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Rosenb\u00fchlgasse 27, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5319-7570","authenticated-orcid":false,"given":"Elif","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Medical Center\u2013University of Freiburg, Faculty of Medicine, University of Freiburg, 79110 Freiburg im Breisgau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1702-1452","authenticated-orcid":false,"given":"Martin","family":"Jonczyk","sequence":"additional","affiliation":[{"name":"Department of Radiology, Charit\u00e9\u2013Universit\u00e4tsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany"}],"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, Rosenb\u00fchlgasse 27, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0552-4850","authenticated-orcid":false,"given":"Michael P.","family":"Br\u00f6nnimann","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Rosenb\u00fchlgasse 27, 3010 Bern, Switzerland"},{"name":"Division of Interventional Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15682","DOI":"10.1038\/s41598-022-20030-z","article-title":"Diagnostic accuracy and safety of CT-guided percutaneous lung biopsy with a coaxial cutting needle for the diagnosis of lung cancer in patients with UIP pattern","volume":"12","author":"Kim","year":"2022","journal-title":"Sci. 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