Korean J Radiol.  2019 May;20(5):844-853. 10.3348/kjr.2018.0555.

Learning Curve of C-Arm Cone-beam Computed Tomography Virtual Navigation-Guided Percutaneous Transthoracic Needle Biopsy

• Ahn SY
• Park CM
• Yoon SH
• Kim H
• Goo JM

• KMID: 2442718
• DOI: http://doi.org/10.3348/kjr.2018.0555

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.

Keyword

Learning curve; Lung; Percutaneous needle biopsy; Cone-beam CT

MeSH Terms

Biopsy, Needle*
Cone-Beam Computed Tomography*
Learning Curve*
Learning*
Lung
Needles*
Pneumothorax
Retrospective Studies

Figure

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  Fig. 1 CUSUM graphs of diagnostic performance. Standard (A) and risk-adjusted (B) CUSUM graphs of diagnostic performance. Upward movement indicates diagnostic failure, whereas downward movement indicates appropriate diagnosis. CUSUM = cumulative summation, H0 = lower decision limit, H1 = upper decision limit

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  Fig. 2 CUSUM graphs of pneumothorax occurrence. Standard (A) and risk-adjusted (B) CUSUM graphs for pneumothorax occurrence.

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  Fig. 3 Impact of failure rate on CUSUM graphs. Standard CUSUM graphs using different failure criteria. A. When less strict failure rates were applied (p0 = 0.10, p1 = 0.20), all operators achieved proficiency after median of 33 procedures. B. When more harsh failure rates (p0 = 0.04, p1 = 0.08) were applied, only 2 reached lower decision limit and 2 operators crossed upper decision limit, suggesting poor performance, even after finishing their training.

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