METHODS: This study is a prospective pilot trial open to patients with peripheral lung lesions > 5 mm and < 30mm who are referred for ENB. Bronchoscopy is performed under generalized anesthesia in the interventional radiology suite with an Artis Zeego (Siemens) robotic-arm, cone-beam CT scanner. All cases are reviewed by our advanced diagnostic bronchoscopy team to determine appropriateness for undergoing ENB. A pre-procedure CT scan is obtained for ENB planning using a superDimension (Covidien) navigation system. Following a routine airway examination, electromagnetic navigation registration and peripheral navigation is performed -with navigation success being defined as a straight on path sufficient for biopsy. Radial endobronchial ultrasound is used to confirm location relative to the target lesion after which a biopsy instrument is deployed. The bronchoscope is then affixed into position and a Cone-beam CT scan is performed to confirm the location of the biopsy instrument relative to the target lesion. Biopsies are taken using a combination of transbronchial needle aspirations, routine cytology brushes, single/triple needle brushes, washings, and forceps biopsies. Rapid on-site examination (ROSE) is used to ensure adequacy of cytology specimens. Variables that are collected for the study include basic patient demographics, size and location of target lesion (lobe and distance to pleura), navigation time, total procedure time, total radiation exposure, navigational success, successful placement of biopsy instrument into target lesion, and final diagnostic yield.