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

Chiao-Yun Tsai; Stella Chin-Shaw Tsai; Guang-Qian Shen; Guan-Liang Robert Guo; Zhe-Luen Gerald Tsui; Ming-Yu Hsieh; Cadmus Yuan; Frank Cheau-Feng Lin

doi:10.1016/j.heliyon.2023.e18329

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

Heliyon. 2023 Jul 15;9(7):e18329. doi: 10.1016/j.heliyon.2023.e18329. eCollection 2023 Jul.

Authors

Chiao-Yun Tsai^{1

2}, Stella Chin-Shaw Tsai^{3

4}, Guang-Qian Shen⁵, Guan-Liang Robert Guo⁵, Zhe-Luen Gerald Tsui⁵, Ming-Yu Hsieh^{6

7}, Cadmus Yuan⁵, Frank Cheau-Feng Lin^{1

2

7}

Affiliations

¹ Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
² Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
³ Superintendents' Office, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
⁴ Department of Postbaccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁵ Department of Mechanical and Computer-Aided Engineering, Feng Chia University, Taichung, Taiwan.
⁶ Department of Pediatric Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁷ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Abstract

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. χ² 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° [0°,80°]; without 14° [0°, 80°], 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°,8°]; without 5°[ 0°,19°], 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',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',18]'; away 9'[ 3',31'], p = 0.027). The learning curve did not improve procedure performance after ten PNCL simulation rounds.

Conclusions: The phantom PNCL simulation education course increased the confidence level, enhanced residents' skill acquisition, and promoted learning satisfaction. The angle reference device helped improve the outcomes of the puncture frequency and reduced angle deviation.

Keywords: Angle reference device; Computed tomography-guided localization; Medical education; Phantom; Pulmonary nodule; Simulation.