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This Article Full Text (PDF) All Versions of this Article: chest.07-2540v1 133/4/897    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Dolina, M. Y. Articles by Bascom, R. PubMed PubMed Citation Articles by Dolina, M. Y. Articles by Bascom, R.

Interbronchoscopist Variability in Endobronchial Path Selection: A Simulation Study

¹Penn State University, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine ²Penn State University, Department of Radiology ³College of Engineering, University Park, PA Depts. of Electrical Engineering, Computer Science and Engineering, and Bioengineering

rbascom{at}psu.edu

Abstract

Background: Endobronchial path selection is important for bronchoscopic diagnosis of focal lung lesions. Path selection typically involves mentally reconstructing a 3D path by interpreting a stack of 2D axial-plane CT sections. Hypotheses: 1. bronchoscopists are inaccurate and overly confident when making endobronchial path selections based on 2D CT analysis; 2. path selection accuracy and confidence improve and become better aligned when bronchoscopists employ path planning methods based on virtual bronchoscopy (VB).

Methods: Studies of endobronchial path selection comparing three path planning methods (standard 2D CT analysis and two new VB-based techniques) were performed. The task was to navigate to discrete lesions located between the 3^rd- and 5^th-order bronchi of the right upper and middle lobes. Outcome measures were cumulative accuracy of making four sequential path selection decisions and self-reported confidence (1= least confident, 5 = most confident). Both experienced and inexperienced bronchoscopists participated in the studies.

Results: In the first study involving a static paper-based tool, cumulative accuracy was 14±3% (mean±SD) using 2D CT analysis (confidence = 3.4±1.3) and 49±15% using a VB-based technique (confidence = 4.2±1.1) (p=0.0001 across all comparisons). For a second study using an interactive computer-based tool, accuracy was 40±28% using 2D CT analysis (confidence = 3.0±0.3) and 96±3% using a dynamic VB-based technique (confidence = 4.6±0.2). Regardless of bronchoscopist experience level, standard 2D CT analysis resulted in poor path selection accuracy and misaligned confidence. The VB-based techniques resulted in considerably higher accuracy and better aligned decision confidence.

Conclusions: Endobronchial path selection is a source of error in the bronchoscopy workflow. VB-based path planning techniques significantly improve path selection accuracy over standard 2D CT section analysis in this simulation format.

Key Words: Bronchoscopy • Lung Cancer • Navigation • Virtual Bronchoscopy • Airway Roadmap