
D. Fielding et al. / Open Journal of Clinical Diagnostics 1 (2011) 9-14 13
EBUS GS probe in the bronchus searching for the cor-
rect bronchus.
Overall our inexperienced candidates scored very well
on their knowledge of CT and endobronchial anatomy
before applying VBNS. This may in part reflect their
exposure to others performing the procedure and better
learning tools now available for training bronchoscopists
[16]. In one other series of both experienced and inexpe-
rienced bronchoscopists Dolina reported a simulation
study where 10 lesions were artificially created at endo-
bronchial sites between 3rd and 5th order bronchi [17].
These lesions were therefore considerably easier to iden-
tify and locate than the lesions in this study which were
placed at non bronchoscopically visible locations typi-
cally at 8th order bronchus level. Similar to our study
bronchoscopists recorded their results on a paper deci-
sion sheet in this case it was the bronchoscope path to
the lesion. Results were that without VB assistance the
correct path was only found in 14%, which improved to
49% with the addition of VB assistance. With a com-
puter tracking tool, perhaps more accurate in terms of
the subjects’ decisions, there was an improvement from
40% to 96% in reaching the target. With either method
the basic results for their subjects withou t the aid of vir-
tual bronchoscopy were therefore lower than our group.
A limitations of our study was that only two of the
cases had endobronchial variations, and cases where
more variations had been present may well have shown a
bigger improvement with VBNS. Also we were not test-
ing manipulation of a bronchoscope to arrive at a certain
bronchus as has been done in other mannequin studies.
Sakurada et al. [5] noted that some bronchi are more
difficult to gain access to such as RB3a and LB 1 & 2c,
however we did not include manual dexterity for access
in this study. In terms of the input of CT data into the
VBNS system a significant number of cases could not be
performed because the CT had not been acquired with
thin enough slices, thereby severely reducing definition
of virtual images.
In summary we have showed virtual bronchoscopy is
an easily aquired skill which improves bronchial local-
isation, even with a high baseline knowledge of anatomy.
Inexperienced bronchoscopists quickly acquire the skill
and this affords them greater potential in-procedure
benefit. This is in line with the use of virtual tools for a
range of bronchoscopic skills [18]. We believe this sim-
ple method should be available to all proceduralists do-
ing EBUS GS, but particularly inexperienced broncho-
scopists as a compliment to their learning of the EBUS
GS method.
5. ACKNOWLEDGEMENTS
Supply of VNS software prototype by Olympus Medical Systems
Tokyo.
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