Training benefits of virtual bronchoscopy prior to Endobronchial Ultrasound Guide sheath

D. Fielding, F. Bashirzadeh, P. Nguyen

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DOI: 10.4236/ojcd.2011.13003                

Abstract

Research questions. How does a virtual bronchoscopy navigation system (VBNS) improve prediction of candidate bronchus across a range of doctors investigating a range of lesions with Endobronchial ultrasound (EBUS) guide sheath? To what extent do benefits of virtual bronchoscopic pre-procedure navigation apply to experienced versus inexperienced bron- choscopists? Methods: Using archived EBUS Guide sheath cases, a comparison was made between identified candidate 4th order bronchus by Computerised tomography (CT) evaluation versus that identified after virtual path creation. Results: From 7 archived cases, 14 doctors identified the correct bronchus in 94 of 98 assessments (95%). Percentage of cases where there was an improvement in localisation by 2 or more 4th order bronchi was 39.8% overall (28.6% – 51.0%), 26.6 for experienced and 53.1 for inexperienced bronchoscopists (p < 0.02). The absolute mean number of 4th order bronchi different between CT and VBNS was 2.0 ± 2.6 overall, 1.2 (range 0-6) for experienced, and 2.8 (range 0-11) for inexperienced bronchoscopists. Virtual Path software calculation time was 8.1 ± 2.7 minutes, compared to 3.6 ± 2.1 minutes by CT. Conclusion: VBNS allowed rapid accurate assessment with minimal software training. Greatest benefits in reduction of procedure time were obtained in inexperienced bronchoscopists, and VBNS could allow more rapid skill development in EBUS GS in these doctors.

Keywords

Virtual Bronchoscopy, Lung Neoplasms and Solitary Pulmonary Nodule/Diagnosis, Transbronchial Biopsy, Three-Dimensional Imaging, Endobronchial Ultrasonography

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Herth, F.J., Ernst, A. and Becker, H.D. (2002) Endobronchial ultrasound-guided transbronchial lung biopsy in solitary pulmonary nodules and peripheral lesions. European Respiratory Journal, 20, 972-974. doi:10.1183/09031936.02.00032001
[2]	Shirakawa, T., Imamura, F., Hamamoto, J., Honda, I., Fukushima, K., Sugimoto, M., et al. (2004) Usefulness of endobronchial ultrasonography for transbronchial lung biopsies of peripheral lung lesions. Respiration, 71, 260-268. doi:10.1159/000077424
[3]	Rivera, M.P. and Mehta, A.C. (2007) Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines, 2nd Edition, Chest, 132, S131-148. doi:10.1378/chest.07-1357
[4]	Kurimoto, N., Miyazawa, T., Okimasa, S., Maeda, A., Olwa, H., Miyazy, Y., et al. (2004) Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest, 126, 959-965. doi:10.1378/chest.126.3.959
[5]	Sakurada, A., Takahashi, N., Sato, M., Miyagawa, Y., Matsumura, H. and Murakami, G. (2005) Are difficulties during transbronchial lung biopsy/brush through a fiberoptic bronchoscope based on the bronchial anatomy? Surgical and Radiologic Anatomy, 27, 94-99. doi:10.1007/s00276-004-0297-0
[6]	Minami, H., Ando, Y., Nomura, F., Sakai, S. and Shimokata, K. (1994) Interbronchoscopist variability in the diagnosis of lung cancer by flexible bronchoscopy. Chest, 105, 1658-1662. doi:10.1378/chest.105.6.1658
[7]	Vining, D.J., Liu, K., Choplin, R.H. and Haponik, E.F. (1996) Virtual bronchoscopy, relationships of virtual reality endobronchial simulations to actual bronchoscopic findings. Chest, 109, 549-553. doi:10.1378/chest.109.2.549
[8]	Brillet, P.Y., Fetita, C.I., Biegelman-Aubry, C., Prêteux, F. and Grenier, P.A. (2007) Quantification of bronchial dimensions at MDCT using dedicated software. European Radiology, 17, 1483-1489. doi:10.1007/s00330-006-0496-7
[9]	Asano, F. (2010) Virtual bronchoscopic navigation. Clinics in Chest Medicine, 31, 75-85. doi:10.1016/j.ccm.2009.08.007
[10]	Shinagawa, N., Yamazaki, K., Onodera, Y., Asahina, H., Kikuchi, E., Asano, F., et al. (2007) Virtual bronchoscopic navigation system shortens the examination time—feasibility study of virtual bronchoscopic navigation system. Lung Cancer, 56, 201-206. doi:10.1016/j.lungcan.2006.12.005
[11]	Yu, K.C., Gibbs, J.D., Graham, M.W. and Higgins, W.E. (2010) Image based reporting for bronchoscopy. Journal of Digital Imaging, 23, 39-50. doi:10.1007/s10278-008-9170-8
[12]	Asano, F., Matsuno, Y., Tsuzuku, A., Anzai, M., Shinagawa, N., et al. (2008) Diagnosis of peripheral pulmonary lesions using a bronchoscope insertion guidance system combined with endobronchial ultrasonography with a guide sheath. Lung Cancer, 60, 366-373. doi:10.1016/j.lungcan.2007.10.022
[13]	Okisama, S. (2007) Endobronchial ultrasonography with a guide sheath and virtual bronchoscopy navigation aids management of peripheral pulmonary nodules. Hiroshima journal of medical sciences, 56, 19-22.
[14]	Asano, F., Yamazaki, K. and Ishida, T. (2008) Usefulness of virtual bronchoscopic navigation in transbronchial biopsy for small pulmonary peripheral lesions: A multicenter, randomized trial. Programs and abstracts of the 15th World Congress for Bronchology, Tokyo, 32.
[15]	Merritt, S.A., Gibbs, J.D., Yu, K.C., Patel, V., Rai, L., et al. (2008) Image-guided bronchoscopy for peripheral lung lesions: A phantom study. Chest, 134, 1017-1026. doi:10.1378/chest.08-0603
[16]	Colt, H.G., Davoudi, M. and Quadrelli, S. (2007) Pilot study of web-based bronchoscopy education using the essential bronchoscopist in developing countries. Respiration, 74, 358-359.
[17]	Dolina, M.Y., Cornish, D.C., Merritt, S.A., Rai, L., Mahraj, R., et al. (2008) Interbronchoscopist variability in endobronchial path selection: A simulation study. Chest, 133, 897-905. doi:10.1378/chest.07-2540
[18]	Ishida, T., Asano, F., Yamazaki, K., et al. (2011) Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: A randomised trial. Thorax.