Development and Evaluation of 3D-Printed Models of Human Tracheobronchial System for Training in Flexible Bronchoscopy

Objective: To develop a 3D-printed model of human tracheobronchial system for assessment and training of cardiothoracic residents in flexible bronchoscopy.

Methods: A dedicated 3D-imaging/engineering software (Mimics Innovation Suite, Materialise) was used to extract the tracheobronchial system from representative CT-datasets of the chest and to subsequently generate a hollow 3D-model which then was printed on an Ultimaker II 3D-printer in PLA and mounted on a stand. In a group of 10 residents the time for bronchoscopy of given ostia using a monitor-equipped flexible bronchoscope (aScope3/aView, Ambu) was measured before and after training. Furthermore, time for retrieval of foreign body from tracheobronchial system was measured before and after training.

Results: Three different 3D-printed models of human tracheobronchial system were generated from representative CT-datasets of the chest. The time for intubation of given ostia (Model 1) at initial assessment varied from 19 to 123 second. Then, the participants were allowed a training period of 15 minute (Model 2). Subsequently, intubation of given ostia was repeated in a different model (Model 3) and ranged from 15 to 19 second documenting a highly significant improvement (p < 0.0001). In addition, identification and retrieval of an artificially placed foreign body in the tracheobronchial system (peanut) showed a significant reduction (p=.006) of bronchoscopy time after training. The study participants uniformly confirmed the value of the training for their performance in patient bronchoscopy.

Conclusion: Representative and realistic models of human tracheobronchial system can be generated using 3D-engineering software and 3D-printing technology. With this models, assessment and training of cardiothoracic residents in flexible bronchoscopy can be performed safely with subsequent significant improvement of handling capability.