A Comparison of 3D-Printed Airway Model Versus Standard Model for Bronchoscopy Training

Abstract

Purpose: Despite advances in bronchoscopy simulation, there is an absence of a low cost and anatomically accurate bronchoscopic model. Most simulation centers currently use models that fail to capture the subtle anatomical details of the airway and are considerably expensive. Recent development in 3D printing capabilities has provided a possible avenue for low cost production of a highly accurate 3D-printed tracheobronchial tree. We aim to evaluate the performance of 3D-printed airway model as compared to the standard model in the setting of bronchoscopy simulation training. Methods: A three-dimensional digital model of the tracheobronchial tree was generated from a CT chest scan using 3D Slicer. The digital model was 3D printed into a flexible nylon tracheobronchial tree (www.shapeways.com), and was subsequently stained to match the coloration of the airway mucosa. Participants with different levels of training (Pulmonary Critical Care FY 1, 2, 3, and Attending) performed bronchoscopy on both models, and graded each using a sliding scale from 0 to 100 based on four categories of performance (look and feel, realism, accuracy, and usefulness as a teaching tool), and overall performance. Assessment scores were compared using paired t-tests. The effect of level of training (FY 1 and 2 vs. 3 and attending) on model assessment was evaluated using repeated measures ANOVA. Results: 30 Pulmonary and Critical Care physicians (FY1=5, FY2=11, FY3=7, and Attending=8) evaluated each model. Mean overall assessment of the 3D printed model was higher than the standard (76 vs. 67, p=0.007). We found the 3D printed model outperformed the standard model in the areas of realism (74 vs. 62, p=0.23) and usefulness as a teaching tool (91 vs. 80, p=0.001). After comparing overall preference separately between early training (FYs 1 and 2) and late training (FY3 and Attending), there was an overall preference towards the 3D printed model in both groups (p=0.02), which was not affected by level of training (p=0.5). Conclusions: 3D printed airway model is a feasible alternative in teaching bronchoscopy. The realism and low cost are two perceived advantages for this new education model. Clinical Implications: Low cost, realistic, educational and clinically useful bronchoscopy teaching models can be readily generated with 3D printing technology.