Introduction: The established method for assessment of mediastinal and hilar lymph nodes is endobronchial ultrasound bronchoscopy (EBUS) with needle aspirations. Previously, we presented an electromagnetic navigation platform for this purpose. There were several issues with the permanent electromagnetic tracking (EMT) sensor attachment on the tip of the experimental EBUS bronchoscope. The purpose was to develop a device for on-site attachment of the EMT sensor. Material and methods: A clip-on EMT sensor attachment device was 3D-printed in Ultem™ and attached to an EBUS bronchoscope. A specially designed ultrasound probe calibration adapter was developed for on-site and quick probe calibration. Navigation accuracy was studied using a wire cross water phantom and clinical feasibility was tested in a healthy volunteer. Results: The device attached to the EBUS bronchoscope increased its diameter from 6.9 mm to 9.5 mm. Average preclinical navigation accuracy was 3.9 mm after adapter calibration. The maneuvering of the bronchoscope examining a healthy volunteer was adequate without harming the respiratory epithelium, and the device stayed firmly attached. Conclusion: Development, calibration and testing of a clip-on EMT sensor attachment device for EBUS bronchoscopy was successfully demonstrated. Acceptable accuracy results were obtained, and the device is ready to be tested in patient studies.@en

Introduction: Effectiveness of e-learning diminishes without the support of a pedagogical model to guide its use. In minimally invasive surgery (MIS), this has been reported as a limitation when technology is used to deliver contents without a sound pedagogical background. Material and methods: We describe how a generic pedagogical model, the 3D pedagogy framework, can be used for setting learning outcomes and activities in e-learning platforms focused on MIS cognitive skills. A demonstrator course on Nissen fundoplication was developed following the model step-by-step in the MISTELA learning platform. Course design was informed by Kolb’s Experiential learning model. Content validation was performed by 13 MIS experts. Results: Ten experts agreed on the suitability of content structuring done according to the pedagogical model. All experts agreed that the course provides means to assess the intended learning outcomes. Conclusions: This work showcases how a general-purpose e-learning framework can be accommodated to the needs of MIS training without limiting the course designers’ pedagogical approach. Key advances for its success include: (1) proving the validity of the model in the wider scope of MIS skills and (2) raising awareness amongst stakeholders on the need of developing training plans with explicit, rather than assumed, pedagogical foundations. Abbreviations: MIS: minimally invasive surgery; TEL: technology enhanced learning.@en

During ultrasound-guided percutaneous interventions, needle localization can be a challenge. To increase needle visibility, enhancements of both the imaging methods and the needle surface properties have been investigated. However, a methodical approach to compare potential solutions is currently unavailable. The work described here involves automated image acquisition, analysis and reporting techniques to collect large amounts of data efficiently, delineate relevant factors and communicate effects. Data processing included filtering, line fitting and image intensity analysis steps. Foreground and background image samples were used to compute a contrast-to-noise ratio or a signal ratio. The approach was evaluated in a comparative study of commercially available and custom-made needles. Varied parameters included needle material, diameter and surface roughness. The shafts with kerfed patterns and the trocar and chiba tips performed best. The approach enabled an intuitive polar depiction of needle visibility in ultrasound images for a large range of insertion angles.@en

Purpose: To present a novel methodical approach to compare visibility of percutaneous needles in ultrasound images. Methods: A motor-driven rotation platform was used to gradually change the needle angle while capturing image data. Data analysis was automated using block-matching-based registration, with a tracking and refinement step. Every 25 frames, a Hough transform was used to improve needle alignments after large rotations. The method was demonstrated by comparing three commercial needles (14G radiofrequency ablation, RFA; 18G Trocar; 22G Chiba) and six prototype needles with different sizes, materials, and surface conditions (polished, sand-blasted, and kerfed), within polyvinyl alcohol phantom tissue and ex vivo bovine liver models. For each needle and angle, a contrast-to-noise ratio (CNR) was determined to quantify visibility. CNR values are presented as a function of needle type and insertion angle. In addition, the normalized area under the (CNR-angle) curve was used as a summary metric to compare needles. Results: In phantom tissue, the first kerfed needle design had the largest normalized area of visibility and the polished 1 mm diameter stainless steel needle the smallest (0.704 ± 0.199 vs. 0.154 ± 0.027, p < 0.01). In the ex vivo model, the second kerfed needle design had the largest normalized area of visibility, and the sand-blasted stainless steel needle the smallest (0.470 ± 0.190 vs. 0.127 ± 0.047, p < 0.001). As expected, the analysis showed needle visibility peaks at orthogonal insertion angles. For acute or obtuse angles, needle visibility was similar or reduced. Overall, the variability in needle visibility was considerably higher in livers. Conclusion: The best overall visibility was found with kerfed needles and the commercial RFA needle. The presented methodical approach to quantify ultrasound visibility allows comparisons of (echogenic) needles, as well as other technological innovations aiming to improve ultrasound visibility of percutaneous needles, such as coatings, material treatments, and beam steering approaches.@en

Radio frequency ablation is commonly used in the treatment of hepatocellular carcinoma. Clinicians rely on imaging techniques, such as medical ultrasound, to confirm an accurate needle placement. This accuracy may improve by means of active needle steering techniques, which are currently in development. Needle steering will likely increase the clinician’s reliance on imaging techniques. This has motivated the study of the echogenicity of steerable needle joint structures. Two needles were manufactured with arrays of kerfs, similar to the compliant joint structures found in steerable needles. The needle visibility was compared to a smooth surface needle and a commercially available RFA needle. The visibility was quantified for both the shaft and tip, by means of a contrast-to-noise ratio (CNR). CNR data were obtained for three insertion angles. The results show that the CNRs of the compliant joint structures were consistently higher than those of the smooth surface needle, whereas they were either higher than or comparable to those of the RFA needle. For acute insertion angles, the bevel tip of the RFA needle had a higher CNR than the conical tip of the kerfed needles, motivating the extension of this visibility study to the full needle design.@en