Children's Hospital Colorado

Pediatric Bronchoscopy Research

Breathing | January 05, 2017

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Pediatric pulmonologist Emily DeBoer, MD, dims the lights. She flips on the bronchoscope, the bulb at the end of its tentacle lights up, and she feeds it into the airway model.

The model looks like a tiny tree preserved in amber. Rather, it's a scale reproduction of a 15-year-old's trachea and bronchi based on CT-scan composites. Looking into the scope, Dr. DeBoer guides its lens through a network of bifurcating tubes, about as pliable as cartilage and anatomically accurate, to the right middle bronchus, typically the easiest to get sample fluid from.

"The holes all look the same," she says. "You could do 100 bronchoscopies and the 3D anatomy is still hard to grasp."

Developing the 3D-printed translucent model

Mimicking the look and feel of human anatomy with hollow tubes encased in a 3D-printed brick of translucent polyurethane is no small feat. Conceived by Dr. DeBoer and bioengineer Jennifer Wagner, and fabricated by Wagners team at the Bioengineering Lab in the basement of Children's Hospital Colorado, the model comes pretty close — with a few notable exceptions. One, the colored tabs stuck in the bronchi mark key practice destinations. Two, the translucent material broadcasts the light of the scope, so you always know exactly where you are.

Three, and perhaps most important: "No anesthesiologist standing over you, no pressure, no risk," Dr. DeBoer says. "In a real patient, you get ten minutes or less. You don't get to just look around for practice."

The impact of bronchoscopy training

Dr Emily DeBoer Bronchoscopy Research

With the model, you do. Using training bronchoscopes in a no-stakes environment, trainees can take all the time they need to get a feel for the procedure. Designed to enhance provider skill and improve patient safety — and unique to Children's Colorado — this low cost, high-fidelity tool is getting impressive results. In one test of the model on trainees with zero scope experience, 92% could identify all lobes of the bronchi successfully after less than two hours of training. The team is currently working on a multi-institution study to determine how quickly trainees can accurately and confidently perform bronchoscopy after using the model.

"The model itself doesn't teach competency," says Dr. DeBoer. "It can't teach decision-making or troubleshooting — that you have to learn in real time. But it can teach you the basic skills. You do it over and over and over, and pretty soon it's all just muscle memory."

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