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Author Spotlight: Learning Systematic Bronchoscopy in a Simulation-Base Setting
Published on: June 23, 2023
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Surgical Process Modeling of Workflow and Performance in Image-Guided Bronchoscopy
Tatiana A Rypinski1,2, Roberto F Casal3, Parvathy S Pillai1,2
1Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Annals of Biomedical Engineering
|October 11, 2025
Summary
Robot-assisted bronchoscopy with cone-beam CT guidance improves targeting accuracy for lung lesions but increases procedure time and radiation dose compared to conventional methods. Surgical Process Modeling quantifies these trade-offs for optimizing clinical workflows.
Area of Science:
- Pulmonology and Interventional Radiology
- Medical Robotics and Imaging Technology
Background:
- Transbronchial sampling of lung lesions is crucial for diagnosis and treatment.
- Emerging technologies like cone-beam CT (CBCT) and robotic assistance aim to enhance bronchoscopic procedures.
- Conventional bronchoscopy relies on 2D fluoroscopy and radial probe endobronchial ultrasound (RP-EBUS) for guidance.
Purpose of the Study:
- To quantify and compare the performance of conventional bronchoscopy versus robot-assisted bronchoscopy with CBCT guidance using Surgical Process Modeling (SPM).
- To evaluate procedural outcomes including cycle time, radiation dose, and geometric accuracy.
Main Methods:
- Statistical SPMs were developed and validated for both conventional and CBCT-guided robot-assisted bronchoscopy.
- 9000 simulation runs were performed for each method to analyze performance differences.
- The influence of patient factors (BMI) and lesion characteristics (location, size) was assessed.
Main Results:
- CBCT-guided robot-assisted bronchoscopy showed a 14% increase in median cycle time (45.3 min vs. 39.6 min) and a 3.2x increase in median patient radiation dose.
- Geometric targeting significantly improved, reducing the rate of missed targets from 22% with conventional bronchoscopy to 2% with CBCT-guided robot-assisted bronchoscopy.
- SPM provided clear 3D visualization of performance, aiding in workflow standardization.
Conclusions:
- Surgical Process Modeling effectively quantifies performance differences between conventional and robot-assisted bronchoscopy for lung lesion biopsy.
- CBCT-guided robot-assisted bronchoscopy offers substantial gains in geometric accuracy at the cost of increased procedure time and radiation dose.
- SPM provides valuable insights for early-stage implementation of new technologies and optimization of clinical workflows.
