Endobronchial Treatment Research Articles

Endobronchial treatment of peripheral tumors: ongoing development and perspectives.

The expanded possibilities to explore the lung deeper with new tools such as electromagnetic navigation bronchoscopy (ENB) or radial probe endobronchial ultrasonography (radial EBUS), combined with miniaturization of traditional local therapies such as radiofrequency ablation (RFA), radiotherapy, cryotherapy or photodynamic therapy, let the bronchoscopists hope for new ways of endoscopic treatments. This challenge could change the practice in the upcoming decades but raise some physical and technical issues. Safety and efficacy need to be solidly established to face the serious concurrence of stereotactic radiotherapy (SBRT) or percutaneous RFA. Here we describe ongoing development and perspectives for endobronchial treatment of peripheral lung tumors.

Cost-effectiveness of endobronchial valve treatment in patients with severe emphysema compared to standard medical care.

Bronchoscopic lung volume reduction using endobronchial valves (EBV) is an effective new treatment option for severe emphysema patients without interlobar collateral ventilation. The objective of this study was to perform an economic evaluation including the costs and cost-effectiveness of EBV treatment compared with standard medical care (SoC) from the hospital perspective in the short term and long term. For the short-term evaluation, incremental cost-effectiveness ratios (ICER) were calculated based on the 6-month end point data from the STELVIO randomized trial. For the long-term evaluation, a Markov simulation model was constructed based on STELVIO and literature. The clinical outcome data were quality-adjusted life-years (QALY) based on the EuroQol5-Dimensions (EQ5D) questionnaire, the 6-min walking distance (6MWD) and the St George's Respiratory Questionnaire (SGRQ). The mean difference between the EBV group and controls was €16 721/patient. In the short-term (6 months), costs per additional QALY was €205 129, the ICER for 6MWD was €160 and for SGRQ was €1241. In the long term, the resulting cost-effectiveness ratios indicate additional costs of €39 000 per QALY gained with a 5-year time horizon and €21 500 per QALY gained at 10 years. In comparison, historical costs per additional QALY 1 year after the coil treatment are €738 400, 5 years after lung volume reduction surgery are €48 415 and 15 years after double-lung transplantation are €29 410. The positive clinical effects of EBV treatment are associated with increased costs compared with SoC. Our results suggest that the EBV treatment has a favourable cost-effectiveness profile, also when compared with other treatment modalities for this patient group.

Patient‐specific goals significantly improve after endobronchial coil treatment in patients with severe emphysema

The Clinical Respiratory JournalVolume 12, Issue 6 p. 2157-2158 LETTER TO THE EDITOR Patient-specific goals significantly improve after endobronchial coil treatment in patients with severe emphysema Jorine E. Hartman, Jorine E. Hartman orcid.org/0000-0001-8765-9673 Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this authorKarin Klooster, Karin Klooster Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this authorNick H.T. ten Hacken, Nick H.T. ten Hacken Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this authorDirk-Jan Slebos, Dirk-Jan Slebos Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this author Jorine E. Hartman, Jorine E. Hartman orcid.org/0000-0001-8765-9673 Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this authorKarin Klooster, Karin Klooster Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this authorNick H.T. ten Hacken, Nick H.T. ten Hacken Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this authorDirk-Jan Slebos, Dirk-Jan Slebos Department of Pulmonary diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsSearch for more papers by this author First published: 13 February 2018 https://doi.org/10.1111/crj.12781Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume12, Issue6June 2018Pages 2157-2158 RelatedInformation

Endobronchial Treatment for Bronchial Carcinoid: Patient Selection and Predictors of Outcome

Background: Traditionally, surgical resection is the preferred treatment for typical carcinoids and atypical carcinoids located in the lungs. Recently however, several studies have shown excellent long-term outcome after endobronchial treatment of carcinoid tumors located in the central airways. This study investigates clinical and radiological features as predictors of successful endobronchial treatment in patients with a bronchial carcinoid tumor. Objectives: To identify clinical and radiological features predictive of successful endobronchial treatment in patients with bronchial carcinoid. Methods: This analysis was performed in a cohort of patients with typical and atypical bronchial carcinoid referred for endobronchial treatment. Several patient characteristics, radiological features, and histological grade (typical or atypical carcinoid) were tested as predictors of successful endobronchial treatment. Results: One hundred and twenty-five patients with a diagnosis of bronchial carcinoid underwent endobronchial treatment. On multivariate analysis, a tumor diameter <15 mm (odds ratio 0.09; 95% confidence interval 0.02–0.5; p = <0.01) and purely intraluminal growth on computer tomography (CT scan) (odds ratio, 9.1; 95% confidence interval 1.8–45.8; p = <0.01) were predictive of radical endobronchial treatment. The success rate for intraluminal tumors with a diameter <20 mm was 72%. Conclusions: Purely intraluminal disease and tumor diameter on CT scan seem to be independent predictors for successful endobronchial treatment in patients with bronchial carcinoid. Based on these data, patients with purely intraluminal carcinoid tumors with a diameter <20 mm on CT scan are good candidates for endobronchial treatment, regardless of histological grade. In contrast, all patients with a tumor diameter ≥20 mm should be directly referred for surgery.

Endobronchial Therapy for Persistent Air Leak

Persistent air leak (PAL) after intercostal drain insertion delays lung reexpantion, increases complications, and results in longer hospital stays and higher treatment costs. A proportion of patients will have comorbid disease or severe underlying lung disease, precluding surgery. We aimed to review the current available endobronchial treatments for PAL and the evidence for their use. The Watanabe spigot had success rates of 57% in early reports. There are numerous case reports and series evaluating endobronchial and intrabronchial valves in the management of PAL. Success rates range from 57 to 95%. Complications were generally minimal and non-fatal. To date, there are no published randomised trials, but one is underway. Endobronchial therapy seems to be a viable and safe alternative for the management of PAL in non-surgical candidates. There is to date no high-level evidence, and our most current practices are based on observational data and expert opinion.

Bilateral cavitary multidrug- or extensively drug-resistant tuberculosis: role of surgery.

Cavitary disease and bilateral lesions are among the risk factors for poor outcome of pulmonary tuberculosis (TB). Our aim was to explore the value and limits of surgery in patients with advanced TB. A retrospective study of 57 consecutive patients who underwent thoracic surgery for culture-positive bilateral cavitary pulmonary TB was performed. Forty-four (77.2%) patients were men and 13 (22.8%) patients were women; their ages were in the range of 18-61 years. Twenty-two (38.6%) patients had multidrug-resistant (MDR) TB and 35 (61.4%) patients had extensively drug-resistant (XDR) TB confirmed with cultures. On admission, 49 (86.0%) patients had sputum smear microscopy positive for acid-fast bacilli. The main indication for surgery was treatment failure manifested as contagious persisting cavities despite best available therapy. The surgical procedures included combinations of pulmonary resections of different levels, selective thoracoplasties and/or endobronchial valve treatment. The operations were performed consecutively, starting with the most affected side. TB therapy preceded the operation for a minimum of 6 months and was continued after the operation on the basis of the patient's susceptibility to drugs for Mycobacterium tuberculosis. We performed 121 operations: 42 in 22 patients with MDR TB (1.9 operations per patient) and 79 procedures in 35 patients with XDR TB (2.3 operations per patient). No deaths occurred in the 1st year. Two late deaths followed, 1 unrelated to and 1 due to TB progression. Ten major complications (1 complication per patient) developed: main bronchus stump fistula (n = 4), prolonged air leak (n = 3), respiratory failure (n = 2) and wound seroma (n = 1). At the 1-month follow-up visit, sputum smear conversion was observed in 11 (68.8%) patients with MDR and in 15 (45.5%) patients with XDR TB. At the late (20-36 months) follow-up visit, culture negativity was achieved in 21 (95.5%) patients with MDR TB and in 23 (65.7%) patients with XDR TB (P = 0.015). Thoracic surgery may significantly improve patients' outcomes and even result in a cure in a good portion of patients with bilateral cavitary MDR and XDR TB and should be considered as the essential element of multimodality treatment for MDR and XDR TB, even in patients with bilateral cavitary disease and borderline respiratory reserves.

The technique of endoscopic airway tumor treatment.

More than half of primary lung cancers are not resectable at diagnosis and 40% of deaths may be secondary to loco-regional disease. Many of these patients suffer from symptoms related to airways obstruction. Indications for therapeutic endoscopic treatment are palliation of dyspnea and other obstructive symptoms in advanced cancerous lesions and cure of early lung cancer. Bronchoscopic management is also indicated for all those patients suffering from benign or minimally invasive neoplasm who are not suitable for surgery due to their clinical conditions. Clinicians should select cases, evaluating tumor features (size, location) and patient characteristics (age, lung function impairment) to choose the most appropriate endoscopic technique. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement and local treatment of endobronchial lesions. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound (EBUS), autofluorescence bronchoscopy (AFB), and narrow band imaging (NBI). Other techniques, such as endobronchial intra-tumoral chemotherapy (EITC), EBUS-guided-transbronchial needle injection or bronchoscopy-guided radiofrequency ablation (RFA), are in development for the use within the airways. These endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer, benign or otherwise not approachable central airway lesions. We aimed at revising several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy (PDT).

Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

Background: Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax. Objective: To assess whether pleural adhesions on pretreatment high-resolution computed tomography (HRCT) scans are associated with pneumothorax occurrence after EBV treatment. Methods: HRCT scan analyses were performed on all patients who received EBV treatment in a randomized controlled trial. Three blinded readers scored adhesions by number and by measuring the longest axis of each pleural adhesion in the treated lung. The Pleural Adhesion Score (PAS) was calculated by adding 1 point for each small pleural lesion (<1 mm), 5 points for each medium-sized lesion (1-5 mm), and 10 points for each large lesion (>5 mm). Results: The HRCT scans of 64 treated patients were assessed, of whom 14 developed pneumothorax. Patients who developed pneumothorax had a higher median number of pleural adhesions, 2.7 (IQR 1.9-4) compared to 1.7 (1-2.7) adhesions in the group without pneumothorax (p < 0.01). The PAS in the group with pneumothorax was higher compared to that in the group without: 14.3 (12.4-24.1) versus 6.7 (3.7-11.2) (p < 0.01). A threshold PAS of ≥12 was associated with a higher risk of pneumothorax (OR 13.0, 95% CI 3.1-54.9). A score <12 did not rule out the occurrence of pneumothorax. Conclusion: A higher number of pleural adhesions on HRCT with a subsequent higher PAS in the treated lung is associated with a higher occurrence of pneumothorax after EBV treatment.

The effectiveness of endobronchial therapy in patients with chemo-resistant tuberculosis when specific process is localized in the lungs apical segments

Objective – to study the effectiveness of the additional methods of endobronchial pathology treatment in patients with chemo-resistant tuberculosis (CRTB) of lungs, that aimed to treat a specific process in bronchi when destructions are localized in the apical segments (S 1+2 ) of lungs. Materials and methods. In order to investigate effectiveness of the additional methods of endobronchial pathology treatment of bronchial mucosa 79 patients with CRTB of lungs were examined. They were divided into 3 groups: basic 1 group, which included 27 patients who were treated by using antimycobacterial drugs endobronchial introduction to S 1+2 with further implementation of intraorganic electrophoresis in S 1+2 zone in combination with systemic receiving of antimycobacterial drugs; the comparison basic 2 group 27 patients who were treated with systemic antimycobacterial therapy in combination with antituberculosis drugs inhalations; and the group included – 25 patients who received only systemic antimycobacterial therapy. Groups were compared by the severity of the process, age and gender. Tracheobronchial tree fiber-bronchoscopy in patients with CRTB of lungs was carried out on the basis of phthisiology and pulmonology department of ZSMU in communal institution Zaporizhzhia regional antituberculosis dispensary, by the author on their own. Character of bronchial mucosa was examined under anesthesia by fiber-bronchoscopes of company Olympus (Japan). Bronchial tree pathology was described according to N. V. Shesterynoy, A. N. Kaliuk (1975) classification. Results of the study were processed with modern methods of analysis on a personal computer with using the Statistical Package license software Statistica ® for Windows 6.0 (StatSoft Inc., № AXXR712 D833214FAN5). Results. The use of antimycobacterial drugs endobronchial introduction to S 1+2 with further implementation of intraorganic electrophoresis in S 1+2 zone contributed significantly increase the frequency of bacterial excretion completion in 1.6 times, the frequency of destructions healing – in 1.8 times with healing time reducing by 1.5 months. It allowed reduce incidences of S 1+2 segmental bronchi meta-tuberculosis stenosis in 4.1 times, which contributed to increase the effectiveness of treatment by 36.6 %. The using of antituberculosis drugs inhalations allowed significantly increase the frequency of bacterial excretion completion in 1.4 times and reduce incidences of S 1+2 segmental bronchi meta-tuberculosis stenosis in 2.4 times that contributed to increase the effectiveness of treatment by 28.9 %. Conclusions. When combined use of antimycobacterial drugs endobronchial introduction to S 1+2 with further implementation of intraorganic electrophoresis in S 1+2 zone in combination with systemic receiving of antimycobacterial drugs, it allows to direct the maximum drug concentration in the affected area, that increase the effectiveness of treatment by 36.6 %.

Changes in Tracheostomy- and Intubation-Related Tracheal Stenosis: Implications for Surgery

This study sought to identify the changing characteristic patterns and locations of stenosis after tracheostomy or intubation and to assess the risk factors associated with perioperative complication and restenosis after primary resection and reconstruction. A retrospective review was performed (January /2012 to March 2015) on patients treated at the University of Arizona Medical Center (Tucson, Arizona) who had symptomatic tracheal stenosis secondary toprolonged intubation or tracheostomy. Data on demographics, surgical approach, and outcome were obtained. Analysis was performed using the χ2 test, Kaplan-Meier estimate of survival, Cox proportional hazards survival analysis, and univariate and multivariate logistic regression. Forty-eight patients were referred for surgical resection, and 36 patients underwent primary resection and reconstruction; 72% of patients had previous endobronchial treatments for stenosis. Fourteen patients hadpostintubation tracheal stenosis, and 22 had tracheostomy-related stenosis (16 percutaneous, 6open tracheostomy). Among all patients, 52.8% had stenosis proximal to or involving the cricoid; 72.7% of patients with tracheostomy-related stenosis had stenosis at or proximal to the cricoid, whereas only 21.4% of the patients with intubation-related stenosis had a similar location. Nineteen patients underwent laryngotracheal resection, and 17 patients had tracheal resection. The mean length of resection was 3.6 cm. A body mass index greater than 35 was associated with increased perioperative complications (p= 0.012). In multivariate analysis, patients younger than 30 years of age at operation had an increased relative risk of recurrence. Recent advances in percutaneous tracheostomy have increased the numbers of patients presenting with proximal tracheal stenosis, thus necessitating more complex subglottic resection and reconstruction. The anastomotic and overall complication rate remains low despite these more complex operations.

Advances in Methods and Patient Selection in Endobronchial Treatment

Advances in Methods and Patient Selection in Endobronchial Treatment

Bilateral Accessory Lung Fissures with a Variant Left Bronchial Tree

Accessory lung fissures are commonly noted, while bronchial branching abnormalities are less frequently found and are proposed to occur in 0.1–2% of the general population. Multiple accessory fissures, variant normal fissures of both lungs, and an altered left bronchial tree are unique to this case and is being reported due to its clinical significance. During a routine dissection of the thoracic cavity of an 85‐year‐old female cadaver, abnormal fissures were noted on both the right and left lungs, which were photographed. The bronchial branching was further dissected by tracing the bronchus from the hilum to the lung tissue. The right lung had a normal oblique fissure, while the horizontal fissure was shallow and incomplete. The left lung had a normal oblique fissure, and a minor fissure was noted running along the junction of the anterior (S3) and superior lingular (S4) bronchopulmonary segments. Accessory fissures were noted on both right and left lungs. The left bronchus was short and displayed an early division into upper and lower divisions. The dissection of the bronchial tree of the left lung showed trifurcation of the upper division into apicoposterior, anterior, and lingular bronchi. The lower division was normal. The right bronchial tree showed normal division. Examination of the heart revealed an atrial septal defect. The other thoracic and abdominal structures were examined and appeared normal. Knowledge of accessory fissures in the lung have importance in the clinical diagnosis of lobar pneumonia versus atelectasis with imaging and during resection of bronchopulmonary segments. Understanding this bronchial variation and anomalies have implications in diagnosis and endobronchial treatment, including airway stenting, bronchoscopy, endoscopy biopsy, and laser therapy.Support or Funding InformationTouro College of Osteopathic Medicine, Department of Anatomy

Bronquio cardíaco accesorio y otras variantes de la anatomía tráqueo-bronquial

Among the variations of bronchial anatomy, we can find dysplastic bronchial branches, an absence of bronchial branches, or supernumerary branches. Although many of them are asymptomatic, it is essential to know them because they may be associated with hemoptysis, recurrent infections, empyema, or complications secondary to various procedures (e.g. endotracheal intubation, brochoscopy, bronchoalveolar lavage, biopsy, endobronchial treatments, stent installation, brachytherapy and lung surgeries among others). In this study we used computed tomography to describe some of the most prevalent bronchial variations, including accessory cardiac bronchus, tracheal bronchus, and bridge bronchus among others.

ED04.01 Surgery in Bronchopulmonary Typical and Atypical Carcinoids

ED04.01 Surgery in Bronchopulmonary Typical and Atypical Carcinoids

One-Year Follow-Up after Endobronchial Valve Treatment in Patients with Emphysema without Collateral Ventilation Treated in the STELVIO Trial

Background: One-way endobronchial valve (EBV) treatment has shown safety and efficacy at 6 months after treatment in patients with severe emphysema and confirmed absence of interlobar collateral ventilation. Longer follow-up in this subgroup is not available. Objectives: To investigate the efficacy and safety of EBV treatment of the STELVIO cohort at a 1-year follow-up. Methods: Emphysema patients who have been treated with EBV in the STELVIO trial were invited for a voluntary 1-year follow-up visit. Both the original treatment group and the control group who crossed over to treatment have been included. Analyses are performed on the patients who attended the 1-year follow-up visit. Results: Sixty-four patients received EBV treatment. At 1 year, 40 patients (26 female; mean age 59 ± 8 years; FEV₁ 0.86 ± 0.29 L; RV 4.56 ± 1.00 L; 6MWD 367 ± 78 m; and SGRQ 56 ± 13 points) visited the hospital. Significant improvements (p < 0.001) were found for FEV₁ (+17%, 95% CI, 11 to 24), RV (-687 mL, 95% CI, -918 to -456), 6MWD (+61 m, 95% CI, 42 to 80), and SGRQ (-11 points, 95% CI, −17 to −6). Two patients died: 1 after 58 days due to progressive respiratory failure and 1 after 338 days of follow-up due to a myocardial infarction. Seventeen percent of the patients underwent valve replacement and 22% of the initially treated patients had permanent valve removal. In 22% of the patients, pneumothoraces occurred before 6 months, and none occurred between 6 and 12 months. Conclusions: EBV treatment results in clinically relevant benefits at 1 year of follow-up. Maintenance bronchoscopies to achieve this are needed. This study supports the use of EBV treatment in carefully selected patients with severe emphysema without collateral ventilation.

Results of bronchoscopic excision in typical carcinoid tumors of the lung in Turkey.

Aim Carcinoid tumors of the lung are the tumors originating from the neuroendocrine cells. Surgical excision remains the gold standard for the treatment. Treatment with interventional bronchoscopic excision has also been reported as an alternative option in typical carcinoid tumors of the lung. The aim of this study was to present results and outcomes in patients who were bronchoscopically treated and followed-up. Methods Data of 14 patients, who had undergone bronchoscopic excision due to typical carcinoid tumor of the lung between April 2008 and July 2015 were retrospectively evaluated. Bronchoscopic excision procedures were performed under general anesthesia, while control bronchoscopies were carried out with flexible bronchoscopy. Time between the first and last bronchoscopies was accepted as the follow-up duration. Results A total of 14 patients was evaluated with eight (57.1%) males. Mean age was 43.57±14.07 (23-68) years. The most common symptoms were shortness of breath and coughing. Mean of 5.69±3.35 (2-12) bronchoscopy procedures were performed in the patients during the diagnosis, treatment and follow-up. Mean follow-up duration was 32.0±19.22 months. At the long-term follow-up, two patients developed 50% stenosis and one patient developed granulation tissue in the endobronchial treatment site. None of the patients developed recurrence during the mean.

Endobronchial valve treatment of destructive multidrug-resistant tuberculosis.

In accordance with the existing hypothesis, the application of an endobronchial valve (EbV) leads to selective curative atelectasis of the affected part of the lung, contributing to early closure of cavities. To assess the effect of EbV treatment on the course of tuberculosis (TB). We compared the efficacy of EbV treatment and complex second-line treatment in treating patients with destructive pulmonary multidrug-resistant TB (MDR-TB). Bacteriological conversion and closure of cavities were selected as criteria to assess the effectiveness of EbV application. A total of 102 patients with destructive MDR-TB were enrolled into the study and randomly divided into two groups: 49 patients had an EbV installed (intervention group) and 53 patients received complex second-line treatment (control group). Complex chemotherapy was administered to both groups throughout the study period. The cure rate in the short- and long-term follow-up periods in the intervention group was shown to be much higher, 95.9% by bacteriological conversion and 67.3% by cavity closure. On comparison with the control group, this was respectively 37.7% and 20.7% (P < 0.0001). The application of EbV treatment can significantly improve the effectiveness of second-line chemotherapy regimens in MDR-TB patients.

Endobronchial valve and vacuum-assisted closure treatment for a complicated air leak problem after cardiac surgery

Endobronchial valve and vacuum-assisted closure treatment for a complicated air leak problem after cardiac surgery

Improvement of physical activity after endobronchial valve treatment in emphysema patients

RationaleBronchoscopic lung volume reduction using endobronchial valves is a promising treatment for severe emphysema patients without collateral ventilation. Physical activity is an important contributing factor for the autonomy, morbidity and mortality of these patients. ObjectiveWe investigated the impact of endobronchial valve treatment on physical activity in severe emphysema patients. MethodsPhysical activity was measured for 7 days by a triaxial accelerometer at baseline and 6 months follow-up after EBV treatment, and compared with standard medical care in a randomized controlled trial. ResultsForty-three patients (77%female, age 59 ± 9years, FEV1 30 ± 7%pred, steps 3563 ± 2213per/day) wore the accelerometer and were included in the analysis. Nineteen patients received EBV treatment and 24 standard medical care. At baseline, physical activity level was comparable between groups. After 6 months, the endobronchial valve group significantly improved compared to the controls in steps/day (+1252vs−148) and locomotion time (+17vs−2 min/day). Change in sit duration (0vs + 27 min/day) did not significantly differ. ConclusionsPhysical activity significantly improved after endobronchial valve treatment in severe emphysema patients. This improvement was without any specific encouragement on physical activity. Clinical trial numberDutch trial register: NTR2876.

TU‐D‐201‐06: HDR Plan Prechecks Using Eclipse Scripting API

Purpose:Automate brachytherapy treatment plan quality check using Eclipse v13.6 scripting API based on pre‐configured rules to minimize human error and maximize efficiency.Methods:The HDR Precheck system is developed based on a rules‐driven approach using Eclipse scripting API. This system checks for critical plan parameters like channel length, first source position, source step size and channel mapping. The planned treatment time is verified independently based on analytical methods. For interstitial or SAVI APBI treatment plans, a Patterson‐Parker system calculation is performed to verify the planned treatment time. For endobronchial treatments, an analytical formula from TG‐59 is used. Acceptable tolerances were defined based on clinical experiences in our department. The system was designed to show PASS/FAIL status levels. Additional information, if necessary, is indicated appropriately in a separate comments field in the user interface.Results:The HDR Precheck system has been developed and tested to verify the treatment plan parameters that are routinely checked by the clinical physicist. The report also serves as a reminder or checklist for the planner to perform any additional critical checks such as applicator digitization or scenarios where the channel mapping was intentionally changed. It is expected to reduce the current manual plan check time from 15 minutes to &lt;1 minute.Conclusion:Automating brachytherapy plan prechecks significantly reduces treatment plan precheck time and reduces human errors. When fully developed, this system will be able to perform TG‐43 based second check of the treatment planning system's dose calculation using random points in the target and critical structures. A histogram will be generated along with tabulated mean and standard deviation values for each structure. A knowledge database will also be developed for Brachyvision plans which will then be used for knowledge‐based plan quality checks to further reduce treatment planning errors and increase confidence in the planned treatment.