Teaching Radial Endobronchial Ultrasound with a Three-Dimensional–printed Radial Ultrasound Model

Abstract

Background Peripheral pulmonary lesion (PPL) incidence is rising because of increased chest imaging sensitivity and frequency. For PPLs suspicious for lung cancer, current clinical guidelines recommend tissue diagnosis. Radial endobronchial ultrasound (R-EBUS) is a bronchoscopic technique used for this purpose. It has been observed that diagnostic yield is impacted by the ability to accurately manipulate the radial probe. However, such skills can be acquired, in part, from simulation training. Three-dimensional (3D) printing has been used to produce training simulators for standard bronchoscopy but has not been specifically used to develop similar tools for R-EBUS. Objective We report the development of a novel ultrasound-compatible, anatomically accurate 3D-printed R-EBUS simulator and evaluation of its utility as a training tool. Methods Computed tomography images were used to develop 3D-printed airway models with ultrasound-compatible PPLs of “low” and “high” technical difficulty. Twenty-one participants were allocated to two groups matched for prior R-EBUS experience. The intervention group received 15 minutes to pretrain R-EBUS using a 3D-printed model, whereas the nonintervention group did not. Both groups then performed R-EBUS on 3D-printed models and were evaluated using a specifically developed assessment tool. Results For the “low-difficulty” model, the intervention group achieved a higher score (21.5 ± 2.02) than the nonintervention group (17.1 ± 5.7), reflecting 26% improvement in performance ( P = 0.03). For the “high-difficulty” model, the intervention group scored 20.2 ± 4.21 versus 13.3 ± 7.36, corresponding to 52% improvement in performance ( P = 0.02). Participants derived benefit from pretraining with the 3D-printed model, regardless of prior experience level. Conclusion 3D-printing can be used to develop simulators for R-EBUS education. Training using these models significantly improves procedural performance and is effective in both novice and experienced trainees.

Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement

“…The European Respiratory Society (ERS) and American Thoracic Society (ATS) published volume‐based guidelines for establishing competence in EBUS over 20 years ago, 71 however, more recent evidence demonstrates that learning curves vary widely among practitioners suggesting that a threshold of cases completed may not be sufficient to establish competency 70 . Use of simulation in training may allow trainees to achieve competence with fewer clinical cases completed 72,73 Frequency with which a sedation plan is developed and documented based on clinical co‐morbidities and anaesthetic/sedation risks Type of measure : process Performance target : >98% Data source : medical notes …”

“…70 Use of simulation in training may allow trainees to achieve competence with fewer clinical cases completed. 72,73 4. Frequency with which a sedation plan is developed and documented based on clinical co-morbidities and anaesthetic/sedation risks Type of measure: process Performance target: >98% Data source: medical notes Information is not required to comprise part of the procedure report, but should be readily available, and should include type of anaesthetic (sedation vs. general anaesthetic), clinician administering anaesthetic, and type and dose(s) of sedation/anaeshetic agents.…”

Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator

“…valuable tools to strengthen various skills by creating a safe and comfortable replica of clinical environment for frequent practice [4]. Simulation training has been shown to improve patient care and management of complicated cases across various procedures including bronchoscopies [5,6] ,laparoscopicsurgeries [7] and other procedures [8][9][10]. Otolaryngologic training programs often use simulators to assist with procedural learning [11][12][13][14].…”