Beyond the Dedicated Suite: A Practical Review of Shared Imaging Platforms for Precision Interventional Pulmonology

Background: Advanced interventional pulmonology (IP) increasingly depends on cone-beam computed tomography (CBCT) and hybrid imaging workflows for the diagnosis and management of intrapulmonary lesions. However, globally, many IP teams still lack a dedicated pulmonology procedure suite in their institution and instead perform cases in rooms originally designed for cardiovascular, neurovascular, interventional radiology, or surgical use. Methods: This review evaluates ceiling-mounted single-plane systems, floor-mounted systems, older and newer biplane angiography suites, robotic CBCT hybrid operating room systems and mobile CBCT systems and their suitability for IP procedures. Results: Based on available literature and institutional experience, ceiling-mounted single-plane systems may offer ergonomic advantages for bronchoscopic IP because they preserve head-side access and procedural ergonomics. Floor-mounted systems remained usable, particularly in older institutions, but could restrict airway-side positioning. Biplane-suite capabilities varied by system generation and configuration; some newer configurations provided CBCT and overlay functions that may facilitate pulmonary workflows. Robotic hybrid systems may provide broad procedural flexibility for complex and combined procedures but require greater institutional support. Mobile CBCT systems represented a practical entry strategy for centers without dedicated infrastructure, while conventional multidetector CT remained valuable for selected percutaneous interventions. Successful adaptation across all platforms depended on room layout, workstation capability, team familiarity, anesthesia support, and multidisciplinary collaboration. Conclusions: Advanced IP programs can be developed without a purpose-built pulmonology suite. Careful adaptation of existing imaging environments may allow centers to expand precision bronchoscopic and percutaneous capabilities according to local resources and workflow realities.