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Peripheral Pulmonary LesionRELIANT 2NCT06654271

Robotic Versus Electromagnetic Bronchoscopy for Pulmonary LesIon AssessmeNT Using Integrated Intraprocedural Imaging

A study testing Robotic assisted bronchoscopy (RAB) and Electromagnetic navigation bronchoscopy (ENB) in people with Peripheral Pulmonary Lesion and Lung Nodule, Solitary, run by Vanderbilt University Medical Center at 4 sites in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

RELIANT 2 is a pragmatic randomized controlled trial. The goal of this study is to compare the diagnostic yield of robotic assisted bronchoscopy with integrated cone beam computed tomography to that of electromagnetic navigation bronchoscopy with integrated digital tomosynthesis in patients undergoing bronchoscopy to… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Robotic assisted bronchoscopy (RAB) and Electromagnetic navigation bronchoscopy (ENB)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
440 participants
Where
4 sitesUnited States
Study dates
11 Nov 2024to 14 Oct 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥ 18 years of age at time of bronchoscopy
  • Scheduled for navigational bronchoscopy for the evaluation of a pulmonary lesion

Who cannot join

  • Patient declines to participate
  • Patients enrolled in another trial which requires the use of one specific navigational platform

Trial locations and contacts

4 sites in 1 country.

United States4 sites
  • Johns Hopkins University

    Baltimore, Maryland, 21287

  • Rush University Medical Center

    Chicago, Illinois, 60612

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37212

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

Other trials in United States

About this study

Official title: Robotic Versus Electromagnetic Bronchoscopy for Pulmonary LesIon AssessmeNT Using Integrated Intraprocedural Imaging: the RELIANT 2 Trial

RELIANT 2 is a pragmatic randomized controlled trial. The goal of this study is to compare the diagnostic yield of robotic assisted bronchoscopy with integrated cone beam computed tomography to that of electromagnetic navigation bronchoscopy with integrated digital tomosynthesis in patients undergoing bronchoscopy to biopsy a pulmonary lesion.

Read the detailed description

Pulmonary nodules are an incredibly common finding, with millions incidentally detected in the US every year. Biopsy is often needed for diagnosis. There are several technologies currently available to biopsy these lesions, including electromagnetic navigational bronchoscopy (ENB) and robotic assisted bronchoscopy (RAB). The latter is used clinically with either conventional fluoroscopy or with cone beam computed tomography (CBCT) guidance, which provides real time 3-dimensional images during the procedure. Recently, CBCT has been integrated with RAB, which allows for automatic update of the lesion location. This update is believed to increase the diagnostic yield of the procedure. Given this new upgrade, we designed this pragmatic, randomized controlled study to test the hypothesis that the diagnostic yield of RAB with integrated CBCT is superior to ENB with integrated digital tomosynthesis in patients undergoing bronchoscopic biopsy of a peripheral pulmonary lesion. Patients undergoing advanced diagnostic bronchoscopy to biopsy a lung lesion will be assigned to either the RAB or ENB based on cluster randomization. Randomization will be revealed each morning before procedures are started. Any advanced diagnostic bronchoscopy scheduled on that day will be performed with the device (RAB or ENB) allocated to that room on that day. All decisions regarding procedure tools, techniques, and patient management will be per usual care and at the discretion of the treating physician.

Being tested
Robotic assisted bronchoscopy (RAB), Electromagnetic navigation bronchoscopy (ENB)
Keywords
Electromagnetic navigation bronchoscopy, Robotic assisted bronchoscopy, Cone beam computed tomography, Diagnostic yield
Medical subject headings
Solitary Pulmonary Nodule

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Robotic assisted bronchoscopy (RAB)Device

    Participants allocated to the robotic assisted bronchoscopy arm will undergo robotic assisted bronchoscopy with integrated cone beam computed tomography

  • Electromagnetic navigation bronchoscopy (ENB)Device

    Participants allocated to the electromagnetic navigation bronchoscopy arm will undergo electromagnetic navigation bronchoscopy with integrated digital tomosynthesis

Study groups in NCT06654271
Study groupRoleWhat they receive
Robotic assisted bronchoscopy (RAB)Active comparatorRobotic assisted bronchoscopy with integrated cone beam computed tomography
Receives: Device: Robotic assisted bronchoscopy (RAB)
Electromagnetic navigation bronchoscopy (ENB)Active comparatorElectromagnetic navigation bronchoscopy (ENB) with integrated digital tomosynthesis
Receives: Device: Electromagnetic navigation bronchoscopy (ENB)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The primary endpoint is the diagnostic yield, defined as the proportion of procedures that result in acquisition of lesional tissue.

    Lesional tissue is defined by the presence of specific pathological findings that readily explain the presence of a pulmonary lesion. The following common pathological findings are pre-specified:

    • Malignancy
    • Specific benign pathologic findings including:
    • Organizing pneumonia
    • Frank purulence/robust neutrophilic inflammation
    • Granulomatous inflammation
    • Other specific benign findings such as hamartoma, amyloidoma or other uncommon causes of peripheral pulmonary lesions with distinctive pathological patterns as adjudicated by an expert lung pathologist.

    Measured: 7 days post-procedure

Secondary outcomes (1)
  1. Duration of bronchoscopy (in minutes)

    Defined as time from the start of airway registration to the removal of the bronchoscope after completion of navigation procedures

    Measured: Duration of procedure, approximately 60 minutes

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Oct 2024
  2. Study start11 Nov 2024
  3. Primary completion14 Oct 2025
  4. Study completion14 Oct 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study will be performed as a pragmatic, cluster randomized controlled trial with parallel group assignment.
Masking
Double blind
Who is masked
Care provider, Outcomes assessor
Enrolment
440 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06654271
Sponsor's protocol ID
241103
Acronym
RELIANT 2
Status last verified
Oct 2025
First submitted
21 Oct 2024
Last updated
20 Oct 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: Individual participant data that underlie the results reported will be made available after de-identification.

Publications

  • Zhang C, Xie F, Li R, Cui N, Herth FJF, Sun J. Robotic-assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Thorac Cancer. 2024 Mar;15(7):505-512. doi: 10.1111/1759-7714.15229. Epub 2024 Jan 29.

    PubMed 38286133
  • Kalchiem-Dekel O, Connolly JG, Lin IH, Husta BC, Adusumilli PS, Beattie JA, Buonocore DJ, Dycoco J, Fuentes P, Jones DR, Lee RP, Park BJ, Rocco G, Chawla M, Bott MJ. Shape-Sensing Robotic-Assisted Bronchoscopy in the Diagnosis of Pulmonary Parenchymal Lesions. Chest. 2022 Feb;161(2):572-582. doi: 10.1016/j.chest.2021.07.2169. Epub 2021 Aug 9.

    PubMed 34384789
  • Low SW, Lentz RJ, Chen H, Katsis J, Aboudara MC, Whatley S, Paez R, Rickman OB, Maldonado F. Shape-Sensing Robotic-Assisted Bronchoscopy vs Digital Tomosynthesis-Corrected Electromagnetic Navigation Bronchoscopy: A Comparative Cohort Study of Diagnostic Performance. Chest. 2023 Apr;163(4):977-984. doi: 10.1016/j.chest.2022.10.019. Epub 2022 Oct 29.

    PubMed 36441041
  • Katsis J, Roller L, Aboudara M, Pannu J, Chen H, Johnson J, Lentz RJ, Rickman O, Maldonado F. Diagnostic Yield of Digital Tomosynthesis-assisted Navigational Bronchoscopy for Indeterminate Lung Nodules. J Bronchology Interv Pulmonol. 2021 Oct 1;28(4):255-261. doi: 10.1097/LBR.0000000000000766.

    PubMed 33734149
  • Gould MK, Tang T, Liu IL, Lee J, Zheng C, Danforth KN, Kosco AE, Di Fiore JL, Suh DE. Recent Trends in the Identification of Incidental Pulmonary Nodules. Am J Respir Crit Care Med. 2015 Nov 15;192(10):1208-14. doi: 10.1164/rccm.201505-0990OC.

    PubMed 26214244
  • Nadig TR, Thomas N, Nietert PJ, Lozier J, Tanner NT, Wang Memoli JS, Pastis NJ, Silvestri GA. Guided Bronchoscopy for the Evaluation of Pulmonary Lesions: An Updated Meta-analysis. Chest. 2023 Jun;163(6):1589-1598. doi: 10.1016/j.chest.2022.12.044. Epub 2023 Jan 11.

    PubMed 36640994
  • Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, Shah PL, Slebos DJ, Valipour A, Wahidi MM, Weir M, Herth FJ. Interventional Bronchoscopy. Am J Respir Crit Care Med. 2020 Jul 1;202(1):29-50. doi: 10.1164/rccm.201907-1292SO.

    PubMed 32023078
  • Agrawal A, Hogarth DK, Murgu S. Robotic bronchoscopy for pulmonary lesions: a review of existing technologies and clinical data. J Thorac Dis. 2020 Jun;12(6):3279-3286. doi: 10.21037/jtd.2020.03.35.

    PubMed 32642251
  • Aboudara M, Roller L, Rickman O, Lentz RJ, Pannu J, Chen H, Maldonado F. Improved diagnostic yield for lung nodules with digital tomosynthesis-corrected navigational bronchoscopy: Initial experience with a novel adjunct. Respirology. 2020 Feb;25(2):206-213. doi: 10.1111/resp.13609. Epub 2019 Jul 2.

    PubMed 31265204
  • Styrvoky K, Schwalk A, Pham D, Madsen K, Chiu HT, Abu-Hijleh M. Radiation dose of cone beam CT combined with shape sensing robotic assisted bronchoscopy for the evaluation of pulmonary lesions: an observational single center study. J Thorac Dis. 2023 Sep 28;15(9):4836-4848. doi: 10.21037/jtd-23-587. Epub 2023 Aug 30.

    PubMed 37868864
  • Paez R, Ratwani AP, Duke JD, Bridwell G, Leonard K, Katsis JM, Pickering EM, Thiboutot J, Chen H, Chen SC, Shojaee S, Yarmus L, Lentz RJ, Maldonado F; Interventional Pulmonary Outcomes Group. Robotic versus electromagnetic bronchoscopy for pulmonary leslon assessment using integrated intraprocedural imaging: Study protocol for the reliant 2 trial. PLoS One. 2025 Dec 3;20(12):e0327611. doi: 10.1371/journal.pone.0327611. eCollection 2025.

    PubMed 41336287
  • Chen SC, Chen H, Paez R, Gatto CL, Lentz RJ, Maldonado F. A randomization strategy for a cluster-randomized controlled trial with variable operating room availability. Contemp Clin Trials. 2025 Oct;157:108057. doi: 10.1016/j.cct.2025.108057. Epub 2025 Aug 28.

    PubMed 40885487

Questions about this trial

What is this clinical trial studying?

A study testing Robotic assisted bronchoscopy (RAB) and Electromagnetic navigation bronchoscopy (ENB) in people with Peripheral Pulmonary Lesion and Lung Nodule, Solitary, run by Vanderbilt University Medical Center at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 20 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The primary endpoint is the diagnostic yield, defined as the proportion of procedures that result in acquisition of lesional tissue. (time frame: 7 days post-procedure). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06654271, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Oct 2025.

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