A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

Gong, Ren Hui; Jenkins, Brad; Sze, Raymond W.; Yaniv, Ziv

doi:10.1117/12.2044112

Cited by 10 publications

(6 citation statements)

References 25 publications

(17 reference statements)

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“…The study participants rated various aspects related to face and content validity and its scores, 5.28 ± 0.76 (out of 7) and 5.48 ± 0.74 respectively, compare well with validation scores of other medical training simulators. 2,5,18,22 However, as these results are based solely on the pilot study this first must be demonstrated in a larger study to more strongly support this comparison. Furthermore, it became apparent that the capabilities of the current method of simulating the fluoroscopy images need improvements.…”

Section: Discussionmentioning

confidence: 93%

Transcatheter Mitral Valve Repair Simulator Equipped with Eye Tracking Based Performance Assessment Capabilities: A Pilot Study

Zimmermann

Arduini

Vicentini

et al. 2021

Cardiovasc Eng Tech

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Background The increase in cardiovascular disease cases that require minimally invasive treatment is inducing a new need to train physicians to perform them safely and effectively. Nevertheless, adaptation to simulation-based training has been slow, especially for complex procedures. Objectives We describe a newly developed mitral valve repair (MVR) simulator, equipped with new objective performance assessment methods, with an emphasis on its use for training the MitraClip™ procedure. Methods The MVR contains phantoms of all anatomical structures encountered during mitral valve repair with a transvenous, transseptal approach. In addition, several cameras, line lasers, and ultraviolet lights are used to mimic echocardiographic and fluoroscopic imaging and with a remote eye tracker the cognitive behaviour of the operator is recorded. A pilot study with a total of 9 interventional cardiologists, cardiac surgeons and technical experts was conducted. All participants performed the MitraClip procedure on the MVR simulator using standard interventional tools. Subsequently, each participant completed a structured questionnaire to assess the simulator. Results The simulator functioned well, and the implemented objective performance assessment methods worked reliably. Key performance metrics such as x-ray usage were comparable with results from studies assessing these metrics in real interventions. Fluoroscopy imaging is realistic for the transseptal puncture but reaches its limits during the final steps of the procedure. Conclusion The functionality and objective performance assessment of the MVR simulator were demonstrated. Especially for complex procedures such as the MitraClip procedure, this simulator offers a suitable platform for risk-free training and education.

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Section: Discussionmentioning

confidence: 93%

Transcatheter Mitral Valve Repair Simulator Equipped with Eye Tracking Based Performance Assessment Capabilities: A Pilot Study

Zimmermann

Arduini

Vicentini

et al. 2021

Cardiovasc Eng Tech

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“…The fluoroscopy simulation of the TSP simulator was judged as very realistic with a score of 4.39 ± 0.71. Gong et al developed a dedicated fluoroscopy simulator and validated it by 11 experts answering questions on a 5‐point Likert scale. The suggested answer: “ Fluoroscopy images are realistic ” was confirmed to a mean score of 4.4 ± 0.50.…”

Section: Discussionmentioning

confidence: 99%

Novel augmented physical simulator for the training of transcatheter cardiovascular interventions

Zimmermann

Steffen

Vicentini

et al. 2019

Cathet Cardio Intervent

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Background: Training in transcatheter cardiovascular skills today represents a significant challenge because of the complexity of the interventions and an extensive use of multiple live imaging technologies. Objectives: We describe the design, the face validation, and content validation of a newly developed physical transseptal puncture (TSP) simulator using additive manufacturing techniques and novel imaging simulation solutions. Methods: The TSP simulator contains a femoral vein catheterization pad, silicon phantoms of the venous system, a replaceable interatrial septum, and cameras to mimic live fluoroscopic and echocardiographic imaging. A validation study was conducted at the University Hospital of Zurich. A total of 14 interventional cardiologists and cardiac surgeons assessed the TSP simulator. Participants performed a TSP on the simulator using standard interventional tools. Face and content validity was demonstrated using a 5-point Likert scale. Results: The TSP simulator is a new training tool for transcatheter cardiovascular interventions. All interventional cardiologists and cardiac surgeons completed the training exercise and scoring. Overall impression was rated (out of 5) 4.04 ± 1.03, haptic feedback scored 4.13 ± 0.82, and the realism of fluoroscopy simulation 4.39 ± 0.79. Usability was rated 4.50 ± 0.63 by the participants, indicating that the simulator could be suitable for training. Conclusion: We demonstrated face and content validity of a new simulator for transcatheter cardiovascular interventions. The TSP simulator's usability, haptic feedback, imaging solutions, and the overall impression of its usage were reported as very realistic. The TSP simulator represents a promising tool for simulation-based training using real interventional toolkits in a mimicked radiological environment. K E Y W O R D S education, simulation training, transseptal puncture

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“…Previous solutions for C-arm fluoroscopy simulation were primarily intended for surgical training purposes. 3,4 Such systems mostly relied on external tracking systems to register the patient (or training phantom) to the coordinate system of the C-arm. Line-of-sight requirements and additional tracking hardware in the operating room (OR), including the direct cost and setup time of these systems, limit their broad utilization for the task of C-arm positioning.…”

Section: Introductionmentioning

confidence: 99%

Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction

et al. 2018

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Positioning of an intraoperative C-arm to achieve clear visualization of a particular anatomical feature often involves repeated fluoroscopic views, which cost time and radiation exposure to both the patient and surgical staff. A system for virtual fluoroscopy (called FluoroSim) that could dramatically reduce time- and dose-spent "fluoro-hunting" by leveraging preoperative computed tomography (CT), encoded readout of C-arm gantry position, and automatic 3D-2D image registration has been developed. The method is consistent with existing surgical workflow and does not require additional tracking equipment. Real-time virtual fluoroscopy was achieved via mechanical encoding of the C-arm motion, C-arm geometric calibration, and patient registration using a single radiograph. The accuracy, time, and radiation dose associated with C-arm positioning were measured for FluoroSim in comparison with conventional methods. Five radiology technologists were tasked with acquiring six standard pelvic views pertinent to sacro-illiac, anterior-inferior iliac spine, and superior-ramus screw placement in an anthropomorphic pelvis phantom using conventional and FluoroSim approaches. The positioning accuracy, exposure time, number of exposures, and total time for each trial were recorded, and radiation dose was characterized in terms of entrance skin dose and in-room scatter. The geometric accuracy of FluoroSim was measured to be [Formula: see text]. There was no significant difference ([Formula: see text]) observed in the accuracy or total elapsed time for C-arm positioning. However, the total fluoroscopy time required to achieve the desired view decreased by 4.1 s ([Formula: see text] for conventional, compared with [Formula: see text] for FluoroSim, [Formula: see text]), and the total number of exposures reduced by 4.0 ([Formula: see text] for conventional, compared with [Formula: see text] for FluoroSim, [Formula: see text]). These reductions amounted to a 50% to 78% decrease in patient entrance skin dose and a 55% to 70% reduction in in-room scatter. FluoroSim was found to reduce the radiation exposure required in C-arm positioning without diminishing positioning time or accuracy, providing a potentially valuable tool to assist technologists and surgeons.

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A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

Cited by 10 publications

References 25 publications

Transcatheter Mitral Valve Repair Simulator Equipped with Eye Tracking Based Performance Assessment Capabilities: A Pilot Study

Transcatheter Mitral Valve Repair Simulator Equipped with Eye Tracking Based Performance Assessment Capabilities: A Pilot Study

Novel augmented physical simulator for the training of transcatheter cardiovascular interventions

Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction

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