Robot-assisted CT-guided interventions: Where are we now and where are we going?

Abstract

Computed tomography (CT)-guided interventions are central to interventional radiology (IR) but remain highly operator-dependent. Robotic assistance has been proposed to improve needle accuracy, reproducibility and radiation safety. While robotics are well established in surgery, their role in CT-guided IR remains evolving. This review synthesises current evidence, maps robotic CT-guided interventions onto the IDEAL framework for procedural innovation, and evaluates where these systems provide measurable clinical value. A narrative review was conducted according to established recommendations for high-quality narrative reviews and informed by SANRA principles. PubMed, Scopus and clinical trial registries were searched for studies evaluating robotic CT-guided percutaneous interventions. Evidence from preclinical, feasibility and comparative clinical studies was synthesised qualitatively and interpreted using the IDEAL framework. Preclinical studies consistently demonstrate improved targeting accuracy and fewer needle adjustments compared with freehand techniques. Clinical studies and systematic reviews support feasibility and safety across biopsy and ablation applications, with current clinical evidence concentrated in the liver, lung, kidney, and musculoskeletal system, particularly for long, oblique, and out-of-plane trajectories. Operator radiation exposure is frequently reduced, while procedure time and patient dose effects are variable. Most published studies correspond to IDEAL stages 1-2b, with emerging Stage 3 randomised evaluation; long-term and registry data remain limited. Robot-assisted CT-guided interventions represent precision-enabling technologies but are not yet standard of care. Current evidence supports selective use in technically complex procedures. Wider adoption will depend on robust comparative studies, economic evaluation and structured implementation frameworks. Question What evidence supports robot-assisted CT-guided interventions in IR, and in which procedures do robotic systems provide clinical benefit? Findings Current clinical evidence is concentrated in liver, lung, kidney, and musculoskeletal interventions, demonstrating improved targeting precision and reduced needle adjustments and operator radiation exposure. Clinical relevance Robot-assisted CT-guided interventions may improve procedural precision and reduce radiation exposure in complex interventions, but wider adoption depends on stronger comparative evidence demonstrating meaningful clinical benefit, workflow efficiency, and cost-effectiveness.