A Pilot Study of Video-motion Analysis in Endovascular Surgery: Development of Real-time Discriminatory Skill Metrics

作者：Rolls A E^*; Riga C V; Bicknell C D; Stoyanov D V; Shah C V; Van Herzeele I; Hamady M; Cheshire N J

来源：European Journal of Vascular and Endovascular Surgery, 2013, 45(5): 509-515.

DOI：10.1016/j.ejvs.2013.02.004

• Simulation
• Endovascular
• Skill
• Assessment
• Objective
• Carotid

Objectives: Accurate assessment and credentialing of physicians is essential. %26lt;br%26gt;Objective motion analysis of guide-wire/catheter manipulation to assess proficiency during endovascular interventions remains unexplored. This study aims to assess its feasibility and its role in evaluation of technical ability. %26lt;br%26gt;Materials and methods: A semi-automated catheter-tracking software was developed which allows for frame-by-frame motion analysis of fluoroscopic videos and calculation 2D catheter tip path-length. 21 interventionalists (6 cardiologists, 8 interventional radiologists, 7 vascular surgeons; 14/21 had performed %26gt;500 endovascular procedures) performed an identical carotid artery stenting procedure (CAS) on a VIST simulator (Mentice, Gothenburg, Sweden). Operators were sub-divided into four categories according to CAS experience: 6 inexperienced (0 CAS-group A), 3 low-volume (1-20 CAS-group B), 5 moderate-volume (21-50 CAS-group C) and 7 high-volume (%26gt;50 CAS-group D) CAS experience. Total PL was calculated for each case and comparisons made between groups. PL was correlated with: quantitative, simulator-derived metrics and qualitative performance scores (generic and procedure-specific) derived from post-hoc video analysis by three blinded observers. %26lt;br%26gt;Results: Group D used 5160.3 (inter-quartile range- IQR 4046.4-7142.9) pixels of movement, compared to 6856.7 (5914.4-8106.9) for group A (p = 0.046); 10,905.1 (7851.1-14,381.5) for group B (p = 0.017); and 9482.6 (8663.5-13,847.6) for group C (p = 0.003). Statistically significant inverse correlations were seen between total PL and qualitative performance scores (rho = -0.519 for generic (p = 0.027) rho = -0.567 for procedure-specific (p = 0.014) scores). PL did not correlate with any of the simulator-derived metrics (errors, contrast volume, total procedure and fluoroscopy times, cine-loops used). %26lt;br%26gt;Conclusion: Endovascular instrument video motion analysis is feasible and may represent a valuable tool for the objective assessment of endovascular skill.

• 出版日期2013-5