Carefully Navigating to the Periphery of the Lung

摘要

Navigating to a peripheral nodule with a bronchoscope is not only a science, but an art. Bronchoscopists are now navigating to the periphery of the lung relying on the nodule location and airway anatomy on the computed tomography chest imaging, as well as using reconstructed 3-dimensional airway map generated by navigation planning software systems. Currently, the most popular navigation platforms are electromagnetic navigation bron-choscopy (ENB), and robotic-assisted bronchoscopy. Successful navigation biopsy technique is a multidisciplinary process including operator competency, navigational platforms used, coordination with anesthesia to minimize computed tomography-to-body divergence, and adequate specimen preparation for confident diagnosis. The cumulative sum (CUSUM) analysis is a method used to continuously monitor performance against an established standard to attain an acceptable failure rates in the procedure performed. It has been used to construct learning curves in different medical specialties tracking trainees' performance. CUSUM analysis has been applied to the learning of endobronchial ultrasound in evaluating novice operators and in assessing bronchoscopists using radial endobronchial ultrasound.