Precision during procedures: Imaging directly integrated

During a procedure, what matters is what the clinical team can see and assess at the critical moment. Imaging integrated directly into the workflow helps clinicians navigate instruments precisely, visualize anatomical structures, and monitor the procedure as it unfolds. Two recent hospital projects show how this integration works in clinical practice and what it requires in terms of workflows and infrastructure.

Asklepios Lung Clinic Gauting has been using robot-assisted bronchoscopy since late August. The technology expands diagnostic options for small pulmonary nodules located in the outer regions of the lung, where they can be difficult to reach with conventional bronchoscopic techniques.

The ION system allows the clinical team to navigate through the airways to targeted peripheral regions of the lung. Robot-assisted bronchoscopy can be combined with three-dimensional cone-beam CT imaging. During the procedure, the team can identify discrepancies between the previously acquired CT scan and the actual location of the pulmonary nodule, verify the position of the instrument, and update the target position as needed.

The primary objective is to obtain a reliable tissue sample for diagnostic classification and subsequent treatment planning. In Gauting, the procedure complements a care pathway that extends from early detection and diagnostic workup to surgical or medical treatment.

At Klinikum Frankfurt (Oder), a new hybrid operating room provides the spatial and technical infrastructure for image-guided procedures. The room combines the capabilities of an operating room with advanced imaging, allowing clinicians to visualize blood vessels, organs, and implants directly during a procedure.

Particularly in complex vascular and cardiac procedures, interventional and open surgical techniques can be performed in the same location. If a minimally invasive procedure requires conversion to open surgery, the team can respond directly in the hybrid OR. This eliminates the need to transfer the patient to another operating room and keeps the necessary procedural capabilities within a single infrastructure.

The technical integration also required changes to the hospital infrastructure. Initial planning for the hybrid OR began in 2023. Following consultations with users and an assessment of different planning options, detailed planning started in October 2024. One structural prerequisite was the relocation of the septic operating room, whose new area was completed at the end of January 2026. Construction of the hybrid OR began immediately afterward. According to the hospital, the overall project represents an investment of approximately €6 million.

The two projects illustrate different requirements for implementing image-guided procedures. In Gauting, the focus is on combining navigation and imaging control within diagnostic bronchoscopy. Frankfurt (Oder) demonstrates how extensively a hybrid OR can affect a hospital’s spatial, technical, and organizational structures.

For comparable investment projects, this points to a practical starting point: planning should begin with the clinical workflow that imaging is intended to support. Requirements for equipment, space, and the clinical departments involved can then be derived from that workflow and coordinated early in the planning process. Particularly for complex infrastructure such as a hybrid OR, user consultation and the early involvement of clinical teams, nursing, technical services, procurement, and other relevant departments can become key elements of implementation.

Sources: Rhön-Klinikum Frankfurt (Oder) (German only), Asklepios Lungenklinik Gauting (German only)