This study plans to collect approximately 30 localization cases from multiple centers within our institution. First, after patient positioning and immobilization in the computed tomography (CT) suite, a chest CT scan is performed. Imaging data are processed using semi-automatic segmentation and rapid reconstruction techniques to generate, in real time, a three-dimensional model that corresponds to the patient's current localization position.

During the construction of the three-dimensional model, patients remain in a fixed position. To reduce anxiety and discomfort associated with waiting, patient education related to pulmonary nodule localization and thoracoscopic surgery is provided during this period. The educational content includes the purpose of the procedure, procedural steps, potential risks, and key points of postoperative care. Once model construction is completed, a metaverse-based XR platform is used in the same setting to overlay the digital twin model onto the patient's

Procedures in this study will be conducted in a CT room. The accuracy of XR-assisted CT-guided localization will be assessed immediately after localization by employing in-room CT to determine the needle tip position and measure the distance to the target tumor.

Perioperative outcomes, including intraoperative blood loss, localization time, operative time, and the rate of localization-related complications, will be measured. We will assess whether the incorporation of the localization system leads to reductions in these parameters.