Impact of Technical Standardization on Pneumothorax and Chest Tube Insertion Rates: A Retrospective Learning Curve Analysis of CT-Guided Lung Biopsies.

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 "safe zone," are intended to reduce this risk. This study evaluates whether PTX incidence and chest tube placement decreased significantly after these technical advances were implemented. : 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-March 2022; n = 45), Partial Knowledge (April-December 2022; n = 18), and Full Knowledge (January 2023-April 2025; n = 55). PTX incidence and chest tube use were compared across periods using chi-square and Fisher's exact tests, while Kaplan-Meier survival analysis was used to evaluate PTX-free survival over time. Overall PTX incidence significantly declined from 71.1% in the Pre-Knowledge Period to 21.8% in the Full Knowledge Period ( < 0.000001). Rates of chest tube placements also decreased from 17.8% to 9.1%, although this difference was not statistically significant ( = 0.372). Kaplan-Meier analysis showed a statistically significant improvement in PTX-free survival over time (indicating improvement in the timing of complication onset; = 0.0042). Procedural optimization was also fostered by a large median intrapulmonary needle length and consistent needle angulation within the safe zone. 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.