PURPOSE: This study evaluates the feasibility of using robotic-assisted bronchoscopy with cone beam computed tomography (RB-CBCT) platform to perform low-dose-rate brachytherapy (LDR-BT) implants in a mechanically ventilated human cadaveric model. Postimplant dosimetry was compared with standard stereotactic body radiation therapy (SBRT) plans. METHODS AND MATERIALS: The RB-CBCT platform was used to place inert LDR-BT seeds into mechanically ventilated human cadavers with percutaneously injected pseudotumors. LDR-BT dosimetry plans were created a priori with a prescription dose of 100 Gy to the pseudotumor plus a 3-mm margin to define a planning target volume. Implant quality was assessed by postimplant dosimetry and seed placement accuracy. BT dosimetry was compared with standard SBRT treatment plans for the same cadaveric tumor volumes. RESULTS: Eight pseudotumors were planned with a total of 41 LDR-BT seeds, with a median of 5 seeds to achieve appropriate target coverage. All 41 LDR-BT seeds were successfully implanted in the 8 pseudotumors using RB-CBCT. On postimplant analysis, the average (± SD) dosimetry to the pseudotumor was a V95% of 99.4% ± 3.3% and D90% of 128 ± 23 Gy. The average distance between the planned and delivered seed location was 3.8 ± 1.1 mm. In comparison with SBRT plans, LDR-BT dose conformity was superior for the ratio of the V50% to the volume of the planning target volume (2.3-4.0, P <
.001) and V25% (5.0 vs 17.5, P <
.001). CONCLUSIONS: RB-CBCT may be a feasible technology for implantation of LDR-BT seeds in peripheral lung tumors and can achieve preplanned dosimetry goals with better dose conformity than SBRT. Further clinical studies are indicated to demonstrate the safety and efficacy of LDR-BT delivered by RB-CBCT for treating early-stage lung cancer.