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Interventional Pulmonology: Advances and Future Directions
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Interventional Pulmonology: Advances and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 25 August 2025 | Viewed by 1243

Special Issue Editors

Dr. Martina Ferioli

E-Mail Website
Guest Editor
Interventional Pulmonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Interests: interventional pulmonology; the diagnosis of lung cancer; bronchoscopy; lung nodules; navigation bronchoscopy
Dr. Piero Candoli

E-Mail Website
Guest Editor
Interventional Pulmonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Interests: bronchoscopy; lung cancer; interventional pulmonology; pulmonary medicine; airway obstruction

Special Issue Information

Dear Colleagues,

Interventional pulmonology integrates advanced techniques and tools to diagnose and treat a wide range of pulmonary disorders using minimally invasive methods. Over the past few decades, interventional pulmonology has experienced an extraordinary evolution, facilitated by the integration of technological advances with the clinical decision-making process of clinicians, enabling a patient-centered diagnostic and therapeutic approach. This Special Issue aims to explore the latest technological innovations and their clinical applications within the field of interventional pulmonology. Topics of interest for publication include, but are not limited to, the role of interventional pulmonology in lung cancer screening, the diagnosis of peripheral lung nodules, mediastinal staging, airway stenting, and the potential therapeutic role of endoscopic techniques. We welcome original research and comprehensive reviews that showcase the recent advances in these areas. By highlighting recent progress, this Special Issue seeks to provide clinicians and researchers with a comprehensive overview of the current state and future potential of interventional pulmonology.

Dr. Martina Ferioli
Dr. Piero Candoli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • interventional pulmonology
  • lung nodule
  • lung cancer
  • diagnosis
  • bronchoscopy
  • rigid bronchoscopy
  • airway stent
  • airway stenosis
  • mediastinal staging

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Published Papers (3 papers)

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Research

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12 pages, 552 KiB  
Article
Elastography Versus B-Mode Lung Ultrasound for the Diagnosis of Iatrogenic Pneumothorax: An Observational, Monocentric, Prospective Study
by Gian Piero Bandelli, Ilaria Bassi, Alessandro Zanforlin, Riccardo Inchingolo, Martina Ferioli, Alessandro Cipolli, Arianna Johanna De Grauw, Marco Ferrari, Thomas Galasso, Filippo Natali, Tommaso Abbate, Francesco Buia, Domenico Attinà, Fabio Niro, Luciana Ingraldi, Elena Nardi, Luigi Lovato and Piero Candoli
J. Clin. Med. 2025, 14(9), 2978; https://doi.org/10.3390/jcm14092978 - 25 Apr 2025
Viewed by 210
Abstract
Background: Thoracic ultrasound (TUS) has emerged as a viable alternative of computed tomography (CT) for pneumothorax diagnosis. Ultrasound elastography (USE), a technique assessing tissue elasticity, has recently been proposed as a novel tool for pneumothorax evaluation. Methods: This prospective, monocentric, observational study [...] Read more.
Background: Thoracic ultrasound (TUS) has emerged as a viable alternative of computed tomography (CT) for pneumothorax diagnosis. Ultrasound elastography (USE), a technique assessing tissue elasticity, has recently been proposed as a novel tool for pneumothorax evaluation. Methods: This prospective, monocentric, observational study aimed to compare the diagnostic accuracy of static and dynamic USE with TUS in detecting iatrogenic pneumothorax after CT-guided transthoracic needle aspiration (TTNA). Results: Thirty-two patients were enrolled, with pneumothorax confirmed via CT in 40.63% of cases. The results showed that elastographic-mode images had significantly higher sensitivity (76.9% vs. 21.2%, p < 0.001) and improved positive and negative predictive values (67.8% vs. 52.4%, p-value 0.01, 82.6% vs. 61.7%, p-value < 0.001, respectively), compared to B-mode images. Concordance between expert and non-expert evaluators was also higher for elastographic images, suggesting improved interpretability. However, dynamic USE did not demonstrate a statistically significant advantage over B-mode videos. Conclusions: These findings suggest that USE may enhance static ultrasound-based pneumothorax detection and provide an objective imaging marker for reports. Further multicenter studies are needed to confirm these findings and explore the potential role of USE in other settings. Full article
(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions)
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11 pages, 1017 KiB  
Article
Effectiveness of Radiation Shields to Minimize Operator Dose in the Bronchoscopy Suite: A Phantom Study and Clinical Application
by Hosang Jeon, Dong Woon Kim, Ji Hyeon Joo, Yongkan Ki, Suk-Woong Kang, Won Chul Shin, Seong Hoon Yoon, Yun Seong Kim, Seung Hyun Yong, Hyun Sung Chung, Taehoon Lee and Hee Yun Seol
J. Clin. Med. 2025, 14(6), 2114; https://doi.org/10.3390/jcm14062114 - 20 Mar 2025
Viewed by 386
Abstract
Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose [...] Read more.
Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system. Full article
(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions)
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Review

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29 pages, 3369 KiB  
Review
Thoracic Ultrasound for Pre-Procedural Dynamic Assessment of Non-Expandable Lung: A Non-Invasive, Real-Time and Multifaceted Diagnostic Tool
by Guido Marchi, Federico Cucchiara, Alessio Gregori, Giulia Biondi, Giacomo Guglielmi, Massimiliano Serradori, Marco Gherardi, Luciano Gabbrielli, Francesco Pistelli and Laura Carrozzi
J. Clin. Med. 2025, 14(6), 2062; https://doi.org/10.3390/jcm14062062 - 18 Mar 2025
Viewed by 477
Abstract
Non-expandable lung (NEL) occurs when the lung fails to fully re-expand after pleural fluid drainage, complicating management and limiting therapeutic options. Diagnosis, based on clinical symptoms, pleural manometry, and traditional imaging, is often delayed to the peri- or post-procedural stages, leading to improper [...] Read more.
Non-expandable lung (NEL) occurs when the lung fails to fully re-expand after pleural fluid drainage, complicating management and limiting therapeutic options. Diagnosis, based on clinical symptoms, pleural manometry, and traditional imaging, is often delayed to the peri- or post-procedural stages, leading to improper management, complications, and higher healthcare costs. Therefore, early, pre-procedural diagnostic methods are needed. Thoracic ultrasound (TUS) has emerged as a non-invasive tool with the potential to enhance diagnostic accuracy and guide clinical decisions, yet, it remains inadequately studied within the context of NEL. We conducted a non-systematic narrative review using a structured methodology, including a comprehensive database search, predefined inclusion criteria, and QUADAS-2 quality assessment. This approach ensured a rigorous synthesis of evidence on TUS in NEL, with the aim of identifying knowledge gaps and guiding future studies. Non-invasive, real-time, bedside M-mode TUS has demonstrated efficacy in predicting NEL prior to thoracentesis by detecting an absent sinusoidal sign and reduced atelectatic lung movement. Emerging experimental techniques, including 2D shear wave elastography (SWE), speckle tracking imaging (STI) strain analysis, the lung/liver echogenicity (LLE) ratio, TUS assessment of dynamic air bronchograms, and pleural thickening evaluation, show additional potential to enhance pre-procedural NEL detection. However, all these methods have significant limitations that require further comprehensive investigation. Despite their significant promise, TUS modalities for early NEL detection still require rigorous validation and standardization before broad clinical use. A multimodal diagnostic approach, combining clinical manifestations, pleural manometry, radiologic and ultrasonographic findings, along with emerging techniques (once fully validated), may provide the most extensive framework for NEL. Regardless of advancements, patient-centered care and shared decision-making remain essential. Further research is needed to improve outcomes, reduce healthcare costs, and enhance long-term treatment strategies. Full article
(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions)
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