PURPOSE: Realistic simulation for bronchoscopy training and device testing can be challenging; especially simulation of peripheral targeting. We assessed the simulation realism of cadaveric human lung containing simulated tumor targets.
METHODS: Three cadaveric human torsos (Science Care, Phoenix, AZ) were obtained. Bilateral chest tubes were placed. The trachea was intubated and connected to a 30 cm H2O pressure source. Five simulated tumors were made in each torso by percutaneous injection of 1.6 ml, 3.6 ml, or 5.6 ml of an aqueous solution of 21% bovine skin gelatin (Sigma-Aldrich, St. Louis, MO), 4% BactoTM agar (Difco Laboratories, Detroit, MI), and 4% barium sulfate powder (ScienceLab.com, Houston, TX); one into each lobe. The solution was heated to 90 degC during mixing and maintained at 45-50 degC prior to injection through a 14-gauge needle. CT was performed and the 3 best-circumscribed targets in each torso were chosen. Three experienced bronchoscopists were each asked to review the CT images of one torso and plan and bronchoscopically implant 3 fiducial markers (Anchored Beacon(r) Transponders, Calypso Medical Technologies, Inc., Seattle, WA) near each of the 3 targets. Guidance was provided by fluoroscopy or electromagnetic navigation (inReach(tm), superDimension, Inc., Minneapolis, MN). Target details from CT scans and operator assessment of model realism were recorded.
RESULTS: The nine selected targets were ellipsoid, had a mean volume of 4.1 cc (range 2.1 cc to 10.7 cc), fluoroscopic visibility, and were peripherally located. Each operator was able navigate the bronchoscopic instruments to the targets. The mean assessment of model realism was 3/3. The mean distance between the implanted transponders and target edge was 1.2 cm.
CONCLUSION: All three operators indicated the model provided a high degree of realism for procedure planning and bronchoscopic targeting with fluoroscopic and electromagnetic guidance.
CLINICAL IMPLICATIONS: This model can be used to train bronchoscopists and to test new devices and techniques where accuracy is important. The model could be also modified to employ animal lungs.
DISCLOSURE: Momen Wahidi, Grant monies (from industry related sources) Ryan L Smith receives support from a grant from Calypso Medical Technologies administered by Washington University; Consultant fee, speaker bureau, advisory committee, etc. Martin L Mayse is a Consultant for Calypso Medical Technologies.; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. The Anchored Beacon Transponder and Delivery Catheter are experimental and not available for sale.