Educational Resources for Bronchoscopy

Introduction

In 1897, Gustav Killian, the "father of bronchoscopy," first viewed the trachea and main bronchi through the larynx via a rigid, hollow tube. He quickly realized that the utility of his new invention was not limited to visualizing the airways. Later that same year, he removed a bone lodged in the right main bronchus of one of his patients. Bronchoscopy and interventional pulmonology were born. Modifications and improvements to the bronchoscope were made over the years. In 1904, Chevalier Jackson equipped the bronchoscope with an electric light source at the distal end and also added a suction channel. Early in the 1960s Shigeto Ikeda devised a means to replace the small electric bulb with glass fibers capable of transmitting brighter light from an outside source. The device worked so well that he requested Machida and Olympus to create a prototype for a flexible fiberscope using fiberoptics. He presented the first flexible bronchoscope at the 1966 International Congress on Diseases of the Chest in Copenhagen. Following his success, he continued to strive to make further improvements to the scope. At the end of the 1980s, Asahi Pentax replaced the fiberoptic bundle with a charge-coupled sensor at the tip of the scope. This videobronchoscope allowed the bronchoscopist to look at a monitor screen instead of through the eyepiece of the scope.

Bronchoscopy is now an integral part of respiratory medicine. Diagnostic indications include tissue diagnosis, detection and staging of lung malignancy, evaluation of diffuse lung diseases like sarcoidosis and idiopathic interstitial pneumonias, pulmonary inspection of burn patients, identification of organisms infecting the respiratory tract and lungs. As a therapeutic modality, bronchoscopy is used to place stents to protect airways vulnerable to collapse or occlusion, to remove foreign bodies or masses and to treat early stage endobronchial malignancy.

Currently we are experiencing a new wave of fascinating techniques in diagnostic and therapeutic technology. Endobronchial ultrasound, electromagnetic navigation, optical coherence tomography and alveoloscopy are the most recent additions to diagnostic bronchoscopy. Recent therapeutic advances include intrabronchial valve placement for nonsurgical lung resection and thermoplasty for difficult-to-treat asthma.

Last Update: February 2010

Search

A Google™ search yielded 1,590,000 sites for the search term "bronchoscopy." Eliminating sites with the words "dictionary" and "encyclopedia" filtered out definitions of the word "bronchoscopy." Removing the words "entrez" and "Pubmed" filtered out journal articles. This resulted in 1,290,000 sites, the large majority of which were guides to help patients about to undergo bronchoscopy have a better understanding of the procedure. Further filtering "patient information" resulted in 382,000 sites. The first 100 sites were reviewed, out of which the best websites are described in detail.

Best Websites

Essential Bronchoscopist

The Essential Bronchoscopist is an interactive, web-based learning program. The original author, Dr. Henri Colt, is a professor at the University of California, Irvine which hosts the site as an educational service.

1. Authority: Dr. Colt is a known leader in the field of bronchoscopy and interventional pulmonology. The site is maintained by Bronchoscopy International, an independent and international group of physicians, educators, researchers, information technology professionals and allied healthcare workers involved in bronchoscopy practice and teaching. Rating: 5

2. Currency: It is an active site that is updated on a regular basis. Rating: 5

3. Accuracy: Site content is based on current evidence. Speculative areas are indicated. Rating: 5

4. Navigation & Readability: The site is well organized and easy to navigate. The site is interactive and makes use of slides and videos as instructional material. Rating: 5

5. Utility: There is no membership necessary. The material is free and can be downloaded easily. It is currently being endorsed as a complementary tool for bronchoscopy instruction by several medical societies. There are self-assessment tools and ability to interact with leading experts. Rating: 5

Summary: Overall, this is an excellent site for health care workers, from students to nurses to respiratory physicians, whose primary interests lie in bronchoscopic training as well as the honing of bronchoscopic skills and knowledge

Art of Bronchoscopy

The Art of Bronchoscopy is another interactive, web-based learning program from Bronchoscopy International. The site provides information and educational material on more advanced bronchoscopic techniques and procedures. At present, the site contains lectures on transbronchial lung biopsy and needle aspiration.

1. Authority: The site is also maintained by Bronchoscopy International. Rating: 5

2. Currency: It is an active site that is updated on a regular basis. Rating: 5

3. Accuracy: Site content is based on current evidence. Speculative areas are indicated. Rating: 5

4. Navigation & Readability: The site is well organized and easy to navigate. The site is interactive and makes use of slides and videos as instructional material. Rating: 5

5. Utility: There is no membership necessary. The material is free and can be downloaded easily. The site is a work in progress and presently contains only four presentations on three topics (oddly labeled 1A, 4A, 4B and 5A). Rating: 3

Summary: This site gives additional and more advanced information to what was offered in the Essential Bronchoscopist. The lectures, however, are few in number. As more topics and lectures are added in the future, it may become a good complement to the Essential Bronchoscopist.

Step by Step

Step by Step is a series of video exercises designed for the development of bronchoscopic skills. It begins at the nose/mouth and, through a series of eight steps, guides the reader through the whole bronchoscopic procedure all the way to the lower lobes.

1. Authority: The site is also maintained by Bronchoscopy International. Rating: 5

2. Currency: The site deals with form and function rather than data. It contains the personal preferences and expert opinions of its authors regarding the instruction of bronchoscopic technique. Rating: 3

3. Accuracy: The site deals with form and function rather than data. It contains the personal preferences and expert opinions of its authors regarding the instruction of bronchoscopic technique. Rating: 3

4. Navigation & Readability: The site is well organized and easy to navigate. The site is interactive and makes use of slides and videos as instructional material. Rating: 5

5. Utility: There is no membership necessary. The material is free and can be downloaded easily. Rating: 5

Summary: Overall, the site is a good instructional guide on the manual, directional and visual aspects of normal bronchoscopic anatomy (lever up, lever down, pull back, go forward) and should be useful to students and beginners in bronchoscopy.

Bronchoscopy Simulator

This site is maintained by ThoracicAnesthesia.com, an Internet-based education, information and reference service for issues related to Anesthesia for Thoracic Surgery. The simulator was developed to teach and review bronchoscopic anatomy using real time video.

1. Authority: ThoracicAnesthesia.com is a member of the University Health Network. Contact information is available for Dr. Peter Slinger from the Anesthesia Department of Toronto General Hospital, but no other authors are mentioned by name. Rating: 4

2. Currency: Timeliness is unimportant for the site, as it is basically a video tour of the anatomy of the bronchial tree. Rating: 3

3. Accuracy: The site content is correct. Rating: 5

4. Navigation & Readability: The site is well organized and easy to navigate. The site is interactive and makes use of videos as instructional material. Before getting to the simulator, a 16-item quiz may be required of the new user. The quiz deals with bronchial anatomy but includes questions on double lumen tube placement which may be annoying to respiratory physicians who do not regularly deal with the placement of these devices. Rating: 4

5. Utility: There is no membership necessary. The material is free and can be downloaded easily. Rating: 5

Summary: Overall, the site is a good instructional guide on the anatomy of the bronchial tree. The controls allow you to go forward and back, up and down in real time as if you were actually controlling a bronchoscope.

Loyola Medical University Medical Education Network (LUMEN) – Bronchoscopy

This website is maintained by LUMEN in conjunction with Loyola University, Chicago. The bronchoscopy page was put up by Dr. Arcot J. Chandrasekhar. It is a nice start-to-finish guide on how to properly perform a bronchoscopy including: consenting the patient, conscious sedation, complications and some procedures like brushing and transbronchial biopsies.

1. Authority: The LUMEN website clearly identifies the mission and objectives. Their contact information is readily available. There is little or no readily- available information on the author of the bronchoscopy page. Rating: 4

2. Currency: The bronchoscopy page itself has no indication when it was last updated. Site content is based on old evidence (the latest cited was 1985). The graduate medical education site, the bigger umbrella page under which it falls, was last updated in October 2006. Rating: 3

3. Accuracy: The site content is accurate and speculative areas are indicated. Rating: 5

4. Navigation & Readability: The site is well organized and easy to navigate. It is interactive by making use of videos which are in the Quicktime format. This is freeware and easily downloadable from the net. However, due to some error, we were not able to view the videos (even after downloading the newest Quicktime version). Rating: 3

5. Utility: There is no membership necessary. The material is free and can be downloaded easily. In detail, the site goes through all the steps required to do a bronchoscopy including prescreening and consents. Rating: 4

Summary: Overall, this is a good site for students and other healthcare workers interested in the detail of the pre-, peri- and post-bronchoscopy procedure.

Medline Plus Tutorial - Bronchoscopy

Among the numerous websites that provide patient guides for bronchoscopy, the tutorial of Medline is the most accessible and friendly for lay people and patients.

1. Authority: The site is maintained by the National Library of Medicine and the National Institute of Health in the US. They have a readily available page to identify their mission. They have available contact information. Rating: 5

2. Currency: The guide was last updated in November, 2005. Most of the information contained, however, does not suffer from being a few years out of date. Rating: 4

3. Accuracy: Site content is accurate. Speculative areas are indicated. Rating: 5

4. Navigation & Readability: The guide comes in three forms, an interactive slide presentation, a noninteractive slide presentation and a PDF text file. Rating: 5

5. Utility: There is no membership necessary. The material is free and may be downloaded. Although all the information is available from other sources, this site is the most interactive and non-healthcare worker friendly. Rating: 5

Summary: Overall, this is a nice site for patients and non-healthcare workers to use as an information resource about bronchoscopy.

Other Important Sites

• European Respiratory Society School Courses- Bronchoscopy
  http://www.ersnet.org/ers/lr/browse/default.aspx?id=630

  A school course on bronchoscopy was held by the European Respiratory Society in 2003 at Crete and the lectures were posted on the web. They range from the history of bronchoscope development, to the finer points of technique, to the future of bronchoscopic practice, all given by leaders in the field. Slides of these lectures may be viewed onsite or downloaded in PowerPoint and/or PDF format but not for free. For nonmembers, a fee of 10 Euros per day of access is required. Membership into the ERS costs 10 to 50 Euros for affiliate membership (with access to all ERS electronic publications) for 1 year.

• Atlas of Digital and Quantitative Bronchoscopy
  http://dpi.radiology.uiowa.edu/nlm/app/atlas/welcome2.html

  This site was established by a group from the Department of Radiology at the University of Iowa. The authors take CT scan images of lung pathologies and reconstruct them as digital 3D models. The images are interesting and help make visualization of CT scans easier. Navigating through the site can be confusing, though, as the layout is not user friendly. Some of the teaching materials may be useful in medical schools although the presentation is inconsistent and does not always download correctly. The site has not been updated since April 2002.

• A Bronchoscopic Picture Atlas
  http://dpi.radiology.uiowa.edu/nlm/app/colon/bronch/index.htm

  This is another site from the Department of Radiology at the University of Iowa. It is a free, web-based atlas of airway pathology as seen through a bronchoscope. They are presented in the form of 45 PowerPoint slides and 8 video clips. Included are papillomatosis, benign and malignant strictures, various cancers, as well as other entities.

• Bronchoscopy for Lung Cancer
  http://www.entusa.com/bronchoscopy.htm

  This is a 5-minute video of a patient with an endobronchial mass undergoing a bronchoscopic procedure with biopsy and brushings of the mass. The author is Kevin T. Kavanagh MD, FACS, Associate Professor of ENT surgery at the University of Kentucky. It is free material and may be viewed in Real® Video or Windows® Media Player formats.

Disclaimer

The author has no personal or financial interest in any of the websites discussed above. The author has no personal or financial interest in any of the websites discussed above.

References

1. Becker HD, Marsh BR. History of the rigid bronchoscope. In: Bolliger CT, Mathur PN, editors. Progress in respiratory research, Vol. 30. Basel, Switzerland: S. Karger AG, 2000. pp. 2-15.
2. Miyazawa T. History of the flexible bronchoscope. In: Bolliger CT, Mathur PN, editors. Progress in respiratory research, Vol. 30. Basel, Switzerland: S. Karger AG, 2000. pp. 16-21.