Statistical surgical process modeling of performance and workflow in bronchoscopy

摘要

<strong>Purpose</strong>. Transbronchial biopsy (TBB) is used in the diagnosis of lung cancer and has multiple approaches in clinical practice, including fluoroscopy with radial probe endobronchial ultrasound (EBUS) and CBCTGuided robot assisted bronchoscopy (CBCT-Guided RAB). This work employs a statistical surgical process model (sSPM) as a quantitative means to compare the workflows and outcomes of these approaches to TBB. <strong>Method</strong>. A sSPM was developed for each guidance approach, with parameterization performed via retrospective review of clinical dose reports which include timestamped dose events. The work reported below specifically details analysis of dose reports from 15 bronchoscopy cases over 15 months to inform and validate statistical distributions of radiation dose and cycle time in a CBCT-Guided RAB sSPM. Dosimetric and temporal segmentation of the time-stamped dose report provided a means of phase estimation, including differentiation of fluoroscopy and CBCT imaging activities and the duration of procedural phases. <strong>Results</strong>. Dose reports provided insight on the exposure ranges and cycle times involved in each phase of TBB. Fluoroscopy events in CBCT-Guided RAB produced DAP levels up 6.0 Gy.cm2 per event, with 76% of the events having dose levels &lt; 1 Gy.cm2. CBCT dose ranged from 6.0-19.0 Gy.cm2 per scan, with 68% of CBCT events having dose levels between 6.0 and 12.0 Gy.cm2. The mean cycle time for three phases in CBCT-Guided RAB were 9.0 min (SD = 3.2 min), 11.2 min (SD = 6.7 min), and 21.3 min (SD = 9.0 min). <strong>Conclusions</strong>. Retrospective review of clinical dose reports was found to be a useful method for phase estimation, parameterization, and validation of dose and cycle times in an sSPM for CBCT-Guided RAB. Patterns in radiation dose were found to distinguish fluoroscopy and CBCT scans and the occurrence and duration of activities surrounding these radiation events were successfully mapped to the phase of the procedure.