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Background Shape-sensing robotic-assisted bronchoscopy (ssRAB) is increasingly used for the diagnosis of pulmonary nodules. Cone-beam computed tomography (CBCT) and fluoroscopy are common adjuncts, used alongside ssRAB to enhance nodule localisation and improve diagnostic yield. However, this inevitably introduces additional radiation exposure. Understanding whether procedural experience influences patients’ radiation exposure is important for optimising safety. We report on the radiation exposure trends at the UK’s first ssRAB centre.Method We conducted a retrospective analysis of prospectively collected procedural data from patients undergoing robotic assisted biopsy of lesions at a tertiary referral centre, from 21st November 2023 to 20th February 2025. Data collected included total radiation dose, CBCT radiation and fluoroscopy radiation. To assess trends over time the dataset was divided into three equal, consecutive cohorts based on procedure date. Patients undergoing sampling of multiple lesions or additional interventions were excluded.Results 267 out of 268 patients had complete radiation dosage and CT spins documented and were included in the analysis. The mean age was 69.4 years and mean BMI was 25.67. 56.6% were female and 28% had underlying lung disease (inc. COPD and ILD). Mean total radiation dose, CBCT radiation, and fluoroscopy radiation was 2.49 mSv, 2.03 mSv, and 0.46 mSv respectively.In the three consecutive cohorts, mean total radiation was 3.12 mSv, 2.34 mSv, and 2.0 mSv, respectively. Mean CBCT radiation was 2.65 mSv, 1.87 mSv, and 1.56 mSv, respectively. Mean fluoroscopy radiation was 0.47 mSv, 0.47 mSv, and 0.44 mSv, respectively.Abstract P214 Figure 1Trends in radiation exposure over sequential procedures Conclusion As procedural experience with ssRAB increased, there was a notable reduction in total radiation dose and CBCT radiation dose. These findings support the development of highly experienced, high volume specialised centres for ssRAB. Further studies are required to understand other factors impacting radiation exposure and the broader impact on service development.