Grace Varughese

Meeting the Client  

It was an incredible experience getting to go to the Wiser Institute in Pittsburgh to learn how residents and medical students practice performing bronchoscopies via simulations before performing them on actual patients.

 

We were asked to redesign/improve the current trainer model (1) that residents use before moving on to the simulation. This trainer model is essentially used to  practice the basic wrist movement needed to operate the bronchoscope. It has a simple clock at the end, where the user can be asked which number to turn the scope to. The current trainer model is good for practicing this skill, but it could be greatly improved with more features! The following design requirements includes what the client asked for as well as personal observations I had while performing a bronchoscopy myself.  

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• Modularity to make it more interesting for residents to navigate so they do not get bored and prematurely move on to the simulation without the proper skills

• Better cover for them to practice in dark environement with light only from a scope

• Anatomy to  include the different anatomical structures of the trachea such as the epiglottis, vocal chords, birforcation of lungs, and bronchioles.

• Curved entrance so user can perform bronchoscopy on trainer model similarly to how it is performed using the simulation.

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Ideation and Foamcore #1

Initially, I really wanted to focus on modularity of allowing the user to choose how hard or easy they wanted the pathway to be.  Therefore, I thought of  the "hinge pathway" concept (2) where the user can add or take away pathways depending on how comfortable they feel performing the bronchscopy. This is seen in the drawing to the left. 

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This led to making my first foamcore model (3). After making this foam core model, I noticed that two different hinges was not needed, so I switched it to one. I also needed to cover the device, so the users could operate it with only the light from the scope. 

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Ideation and Foamcore #2​

Therefore, I refined the idea and decided to print transparent film pictures of the anatomy of the trachea which included the vocal chords, the biforcation of the lungs, and bronchioles in the lungs (4). This would allow the user to have a good idea of what they will see in the simulation before actually going though it. It also still gives them the mobility to practice with whatever type of pathways they wish to practice with ranging from easy (just the clock) to hard (with vocal chords, biforcation, and bronchioles) (5).

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Various techniques 

I took this design concept to Tom Dongilli, the Director of Operators at the Wiser Institute, and he gave me some helpful feedback.  He said to make everything closer to more accurately represent the human trachea (average human trachea is 22 cm), and he also said to only focus on four types of pathways which include normal airway, enclosed airway due to allergic reaction, normal biforaction, and biforcation with an occulsion such as a tumor. I took this advice and implemented various techniques to make the final prototype.

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Various techniques were incorporate including

• CAD: I used Solidworks to model the basic structure of the device I had so far (6), and after modeling it, I noticed how I needed to update the stand (7) to make the pathways more stable. 

• Photoshop: I photo-shopped the pictures of the four different pathways (8,9) to make sure they were all re-scaled to the same size and to include a tumor into one of the pictures.

• Transparent film printing: I used a ink jet laser printer to print out the pictures on transparent OHP film.

• Laser cutting: To make the case for transparent film which slides into the stand (stand shown in pic 7), I laser cutted 2 pieces of 1/16'' clear acrylic material (10). Then , I glued the transparent film between the two pieces . This created a slide that is quite similar to slides placed under a microscope. Moreover,  I laser cutted the base and two sides of the device out of 1/4'' MDF. Then I cut the base of the trachea tube out of 1/8'' blue acrylic material (11). 

• 3D-Printing: I 3D-printed the trachea tube stand as well as the cover. This stand helps keep the trachea tube propped at a curved angle (12,13). I also printed a case for the 4 slides to be stored in (14).

• Mold Casting: I mold casted the orginal clock from the current trainer model because I thought that concept was still beneficial for practicing the basic wrist movements (15).

• Foam core: I used foam-core and wrapped it in cloth so the cover can enclose the device similar to an iPad case function which magnetically folds over. This cover allows the user to operate the bronchoscope in a complete dark environment (16).

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Final Design

The final prototype (17,18) included :

• Modularity where the user can slip different transparent film slides into the two stands to make it as easy or hard as needed

• Curved stand where the trachea tube can be placed at a curved angle so user can intubate from above

• Case for the 4 transparent slides to be stored 

• Cover that magnetically fits onto the device to create a completely enclosed environment 

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