Design and development of low cost prototype for the training of bronchoscopy examination

Background and Goal of Study: In the last decade, simulation in medicine has attained a fundamental role in the training of medical students as well as on improving and maintaining skills of expert clinicians.  In anesthesia and intensive care  bronchoscopy is a procedure that carries some risks, such as bleeding, perforation etc., Thus there is the need of alternative methods for training when patients are involved. Currently, physicians can use two distinct families of simulators, one based on Virtual Reality (VR) and the other on physical models. Our aim is to build a low cost and easy to use prototype integrating both the physical and the VR simulators to provide a complete and realistic system for  training bronchoscopy examination
Materials and Methods: Images, acquired with Computed Tomography (DICOM  format) with 0,625 mm slice thickness, are used to create a 3D digital model of  the tracheo-bronchial tree. 
This model is used to create both a physical model to train manual skills and a VR model to provide a realistic visual feedback. To create the physical prototype we imported and elaborated the digital model in the CAD software, then by using a stereolithography process, we 3D printed a physical model of the tracheo-bronchial tract that could be navigated with a real bronchoscope. To create the VR model that the operator can navigate with a virtual camera, the digital model was imported and elaborated in Unity 3D .
The physical and the VR models are connected so that each movement of the real endoscopic camera inside the physical model corresponds to a movement of the point of view in the VR model. A simple led-based system allowed computing the coordinates of the tip of the bronchoscope inside the physical model. These coordinates are sent to Unity 3D allowing the simultaneous navigation in the VR model.  
Results and Discussion: Both components of this simulator are very realistic: the physical model of tracheo-bronchial tree is similar to the real airways; the bronchoscopic images of the VR system were compared with images of a real bronchoscopy, showing an high level of similarity. Furthermore, the system is low-cost: the software is open-source and the used 3D printer process  not expensive.
Conclusion: This system represents a good and innovative simulator combining visual and haptic feedback for bronchoscopy exam training. This prototype might help enhancing clinicians’ skills in a safe and efficient way.



09 / Design and development of a low cost prototype for the training of bronchoscopy examination