Regardless of the procedure (endoscopy, angiography, gastrointestinal fluoroscopy, or surgery), real-time image capture by tomosynthesis is important in making the procedure easier and to improve precision. We have investigated real-time tomosynthesis-guided bronchoscopy, a new technique that enables confirmation of the position of biopsy instruments, such as forceps or needle, inside a lesion, along transverse and anteroposterior directions. Normal fluoroscopy is quite capable of confirming positions in a transverse direction but has trouble confirming positions in the anteroposterior plane. To date, confirming the position of biopsy instruments in the anteroposterior direction has required the use of a C-arm or manual shifting of a patient in the lateral recumbent position during examination. Confirming the position of a lesion is not always easy due to the presence of mediastinal structures. The use of tomosynthesis to capture images will make it very easy to ascertain and correct the positional relationship between a peripheral pulmonary lesion and the biopsy instruments. An illustration of an actual examination setup is shown in Fig. 15.1. The biopsy instrument inside the lesion can be confirmed on the tomosynthesis screen by reconstructing contiguous cross sections in the anteroposterior direction from the back through the anterior chest (Figs. 15.2 and 15.3). However, movement of the gantry in a longitudinal direction along the body for tomosynthesis prevents the operator from standing at the head of the patient during bronchoscopy; instead, the operator needs to be positioned on the side of the patient (Fig. 15.1), making control of the bronchoscope somewhat difficult. Techniques that have real-time imaging capabilities need further development. In addition, making the capture of tomosynthesis images possible by gantry movement in both transverse and lateral directions will certainly increase the amount of freedom allowed to the operator during procedures.