Make a small dermatotomy using a size 11 scalpel blade. This avoids resistance of skin and bending of the needle. Select a size 22 spinal needle. Attempt to insert the needle into the lesion. Ensure placement of the needle into the lesion.
Intermittent fluoroscopy is performed to guide the advancement of the needle towards the lesion.
Assess in both planes to be sure that the needle is in the lesion. Do not bend the needle. I insert the needle during quiet breathing. Many prefer to insert the needle during breath holding. This usually confuses the beginner and the patient may sometimes take a deep breath increasing the likelihood of a tear of the lung.