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Robotic Systems Evaluation for Peripheral Pulmonary Lesions (RISE Trial)

29. juli 2026 opdateret af: Case Comprehensive Cancer Center

Robotic Systems Evaluation for Peripheral Pulmonary Lesions: A Randomized Trial (RISE Trial)

This is an investigator-initiated cluster randomized control trial. The primary objective is to compare the diagnostic yield of two Food and Drug Administration (FDA) cleared national robotic assisted bronchoscopy platforms - the Monarch™ Platform and the ION™ Endoluminal System - in participants undergoing bronchoscopy to evaluate peripheral pulmonary lesions (PPLs). Participants will undergo their scheduled robotic assisted bronchoscopy (RAB) using one of these platforms.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Roughly 1.6 million lung nodules are identified every year in the United States. When tissue sampling is required, robotic-assisted bronchoscopy (RAB) systems are increasingly used to reach peripheral targets inaccessible to standard bronchoscopy.

Robotic-assisted bronchoscopy (RAB) has rapidly evolved as a promising modality for sampling PPLs. Two FDA-cleared robotic platforms are currently in clinical use: the ION™ Endoluminal System (Intuitive Surgical, Inc., Sunnyvale, CA) and the Monarch™ Platform (Johnson & Johnson MedTech / Auris Health, Redwood City, CA). Both platforms were cleared through the FDA 510(k) pathway, which requires demonstration of substantial equivalence to predicate devices but does not mandate comparative effectiveness data prior to commercialization.

The ION™ system uses shape-sensing fiber-optic technology to track catheter position with high precision throughout the bronchial tree. It has been shown in multiple studies to achieve diagnostic yields ranging from 67-85%, with enhanced performance when combined with intraprocedural cone-beam computed tomography (CBCT). The recent RELIANT trial (the first cluster-randomized controlled trial in interventional pulmonology) demonstrated that ION™ was non-inferior to electromagnetic navigation bronchoscopy (ENB) with integrated digital tomosynthesis, with diagnostic yields of 77.8% and 75.5% respectively (P for non-inferiority = 0.007).

The Monarch™ platform uses a hybrid approach combining electromagnetic tracking and robotic catheter control with a continuously visualizing bronchoscope (4-way articulation). A key feature of the Monarch™ is direct bronchoscopic vision throughout navigation, enabling real-time assessment of the airways and the target lesion. The Monarch™ has received additional FDA clearance for bronchoscopic transparenchymal nodule access (BTPNA), allowing access to lesions without a direct airway path. Published studies report diagnostic yields of 66-81% for the Monarch™ platform, though most are single-center, non-randomized studies with varying definitions of diagnostic yield, co-intervention use, and did not fully use integrated intraprocedural imaging (including fluoroscopy and CBCT, as available and integrated).

Critically, no randomized or high-quality comparative study has directly compared the ION™ and Monarch™ platforms head-to-head with integrated intraprocedural imaging. As both systems are now available at University Hospitals Cleveland Medical Center and represent substantial capital expenditures, high-quality prospective comparative data are urgently needed to guide clinical decision-making and resource allocation. This trial leverages the existing dual-platform clinical infrastructure at UHCMC to conduct a pragmatic, cluster-randomized, non-inferiority trial embedded within routine clinical care

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

398

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • Ohio
      • Cleveland, Ohio, Forenede Stater, 44106
        • University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center
        • Kontakt:
        • Ledende efterforsker:
          • Sameer K Avasarala, MD

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  • Age ≥ 18 years at the time of bronchoscopy.
  • Scheduled to undergo navigational bronchoscopy (either ION™ or Monarch™) for the evaluation of a pulmonary lesion at University Hospitals Cleveland Medical Center (UHCMC).
  • Able and willing to provide written informed consent.

Exclusion Criteria:

  • Enrolled in another clinical trial that requires the use of a specific navigational/robotic bronchoscopy platform.
  • Enrolled in another bronchoscopy-related clinical trial.
  • Participant or legally authorized representative declines participation.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Diagnostisk
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Andet: Monarch Platform
This study is being conducted at a hospital that has two bronchoscopy procedure rooms (BPRs). The unit of the randomization is the BPR day. Each day, one BPR will be randomized to the Monarch platform and the other to the ION platform. Participants in this arm will have undergone their RAB via the Monarch platform.
The Monarch™ (Monarch) platform is one of two FDA-cleared robotic platforms currently in clinical use for robotic-assisted bronchoscopy (RAB). It uses a hybrid approach combining electromagnetic tracking and robotic catheter control with a continuously visualizing bronchoscope (4-way articulation). A key feature of the Monarch platform is direct bronchoscopic vision throughout navigation, enabling real-time assessment of the airways and the target lesion.
Andre navne:
  • Monarch™
Andet: ION Platform
This study is being conducted at a hospital that has two bronchoscopy procedure rooms (BPRs). The unit of the randomization is the BPR day. Each day, one BPR will be randomized to the Monarch platform and the other to the ION platform. Participants in this arm will have undergone their RAB via the ION platform.
The ION™ Endoluminal System (ION) platform is one of two FDA-cleared robotic platforms currently in clinical use for robotic-assisted bronchoscopy (RAB). It uses shape-sensing fiber-optic technology to track catheter position with high precision throughout the bronchial tree.
Andre navne:
  • ION™ Endoluminal System

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Diagnostic yield defined as the proportion of procedures that result in the acquisition of lesional tissue
Tidsramme: Up to Day 14
Diagnostic yield is defined as the proportion of procedures that result in the acquisition of lesional tissue. This will be measured for both procedures conducted via the Monarch platform and the ION platform.
Up to Day 14

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Duration of the robotic bronchoscopy procedures
Tidsramme: Day 0
The duration of the robotic bronchoscopy procedure will be measured in minutes for both the Monarch platform and the ION platform.
Day 0
Safety, measured by the number of complications
Tidsramme: Up to Day 7
Safety will be measured by the number of complications that occur within 7 days of the procedure for both the Monarch platform group and the ION platform group.
Up to Day 7
Radiation exposure
Tidsramme: Day 0
Radiation exposure is defined as the radiation dose delivered to the participant during the study bronchoscopy and is recorded as a dose area product in milligray per centimeters squared (mGy/cm2). Radiation exposure is measured for both the Monarch platform group and the ION platform group.
Day 0
Rate of additional diagnostic procedures required within 12 months
Tidsramme: Up to 12 months
The rate of additional diagnostic procedures required within 12 months of the study bronchoscopy will be assess for both the Monarch platform group and the ION group.
Up to 12 months
Diagnostic accuracy at 12 months post-biopsy
Tidsramme: Up to 12 months
Diagnostic accuracy at 12 months post-biopsy is defined as the number of true positive lesions (malignant) plus true negative lesions (specific benign diagnosis) with no evidence of malignancy at 12-month follow-up (no interval biopsy diagnostic of malignancy, regression on CT or stable size with no plan for repeat diagnostic procedure), divided by the total number of biopsied lesions. This will be assessed for both the Monarch platform group and the ION platform group.
Up to 12 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Ledende efterforsker: Sameer K Avasarala, MD, Case Comprehensive Cancer Center, University Hospitals

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

1. august 2026

Primær færdiggørelse (Anslået)

1. august 2027

Studieafslutning (Anslået)

1. august 2027

Datoer for studieregistrering

Først indsendt

23. juli 2026

Først indsendt, der opfyldte QC-kriterier

29. juli 2026

Først opslået (Faktiske)

30. juli 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

30. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

29. juli 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • CASE3526

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

JA

IPD-delingstidsramme

The data will become available 3 months following publication of outcomes and will remain available for at least 5 years.

IPD-delingsadgangskriterier

Data will be made available to researchers who provide a methodologically sound proposal that has been approved by University Hospitals Institutional Review Board and the study executive committee.

IPD-deling Understøttende informationstype

  • STUDY_PROTOCOL
  • SAP

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ingen

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ja

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