Simulation education utilizing phantom and angle reference guide in pulmonary nodule CT localization

Objective: The incidence of sub-centimeter pulmonary nodules has been increasing along with the use of low-dose computed tomography (LDCT) as a screening tool for early lung cancer detection. In our institution, pulmonary nodule computed tomography-guided localization (PNCL) is performed preoperatively with the laser angle guided assembly (LAGA), an angle reference device. This study aims to investigate the efficacy of postgraduate education in a phantom simulation of PNCL, with or without LAGA.Setting design: This prospective study was conducted in an academic hospital in Taiwan. Seven thoracic surgery residents and three experienced senior physicians were recruited to perform PNCL using a phantom simulation, with or without LAGA, for five nodules each and complete a questionnaire. Performance data were collected. & chi;2 tests, Mann-Whitney U test, univariate and multivariate linear regression were used for statistical analyses.Results: The confidence level increased from median 7[range 1, 9] to 8, range [6,9] (p = 0.001) before and after the simulation education course. The scores of enhanced PNCL ability and course satisfaction were as high as 8 [5,9], and 9 [7,9]. LAGA enabled broader puncture angles (with 27.5 degrees [0 degrees ,80 degrees]; without 14 degrees [0 degrees, 80 degrees], p = 0.003), a lower puncture frequency (with 1 [1,4]; without 2 [1,5], p < 0.001), and a smaller angle deviation (with 3[ 0 degrees ,8 degrees]; without 5 degrees[ 0 degrees ,19 degrees], p = 0.002). Pleural depth in millimeters was associated with increased puncture frequency (0.019 [0,010,0.028]) and procedure time (0.071'[ 0.018,0.123']. The PNCL-experienced physicians performed the procedure in less time (- 2.854'[-4.646 & PRIME;,1.061']. The traverse direction toward the mediastinum diminished the frequency (toward 1[ 1,3]; away 1 [1,5], p = 0.003) and time (toward 7.5'[2 & PRIME;,18]'; away 9'[ 3',31'], p = 0.027). The learning curve did not improve procedure performance after ten PNCL simulation rounds.

Automated summary

Postgraduate education and the use of LAGA in PNCL can improve confidence level, enhance PNCL ability, and optimize puncture angles. Pleural depth is associated with puncture frequency and procedure time, while experienced physicians and puncture towards the mediastinum can reduce frequency and time. There is no improvement in procedure performance with the learning curve.