Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Learning Curve of C-Arm Cone-beam Computed Tomography Virtual Navigation-Guided Percutaneous Transthoracic Needle Biopsy

  • Su Yeon Ahn (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine) ;
  • Chang Min Park (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine) ;
  • Soon Ho Yoon (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine) ;
  • Hyungjin Kim (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine) ;
  • Jin Mo Goo (Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine)
  • Received : 2018.08.14
  • Accepted : 2019.01.11
  • Published : 2019.05.01
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Abstract

Objective: To evaluate the learning curve for C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous transthoracic needle biopsy (PTNB) and to determine the amount of experience needed to develop appropriate skills for this procedure using cumulative summation (CUSUM). Materials and Methods: We retrospectively reviewed 2042 CBCT virtual navigation-guided PTNBs performed by 7 novice operators between March 2011 and December 2014. Learning curves for CBCT virtual navigation-guided PTNB with respect to its diagnostic performance and the occurrence of biopsy-related pneumothorax were analyzed using standard and risk-adjusted CUSUM (RA-CUSUM). Acceptable failure rates were determined as 0.06 for diagnostic failure and 0.25 for PTNB-related pneumothorax. Results: Standard CUSUM indicated that 6 of the 7 operators achieved an acceptable diagnostic failure rate after a median of 105 PTNB procedures (95% confidence interval [CI], 14-240), and 6 of the operators achieved acceptable pneumothorax occurrence rate after a median of 79 PTNB procedures (95% CI, 27-155). RA-CUSUM showed that 93 (95% CI, 39-142) and 80 (95% CI, 38-127) PTNB procedures were required to achieve acceptable diagnostic performance and pneumothorax occurrence, respectively. Conclusion: The novice operators' skills in performing CBCT virtual navigation-guided PTNBs improved with increasing experience over a wide range of learning periods.

Keywords

Acknowledgement

This study was supported by the Industrial Technology Innovation Program funded by the Ministry of Trade, Industry & Energy (MOTIE), Republic of Korea (grant number: 10080531) and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HC15C3390).

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