Simulation Training in Neuroangiography: Transfer to Reality

Abstract

Purpose Endovascular simulation is an established and validated training method, but there is still no proof of direct patient's benefit, defined as lower complication rate. In this study, the impact of such a training was investigated for rehearsal of patient-specific cases as well as for a structured simulation curriculum to teach angiographer novices. Materials and Methods A total of 40 patients undergoing a diagnostic neuroangiography were randomized in a training and control group. In all training group patients, the angiographer received a patient-anatomy-specific rehearsal on a high-fidelity simulator prior to the real angiography. Radiation exposure, total duration, fluoroscopy time and amount of contrast agent of the real angiography were recorded. Silent cerebral ischemia was counted by magnetic resonance diffusion-weighted imaging (DWI). Additionally, the first 30 diagnostic neuroangiographies of six novices were compared (n total = 180). Three novices had undergone a structured simulation curriculum; three had acquired angiographic skills without simulation. Results No differences were found in the number of DWI lesions or in other quality measures of the angiographies performed with and without patient-specific rehearsal. A structured simulation curriculum for angiographer novices reduced fluoroscopy time significantly and radiation exposure. The curriculum had no influence on the total duration of the examination, the amount of contrast medium or the number of catheters used. Conclusion There was no measurable benefit of patientanatomy-specific rehearsal for an unselected patient cohort. A structured simulation-based curriculum to teach angiographic skills resulted in a reduction of fluoroscopy time and radiation dose in the first real angiographies of novice angiographers. Level of Evidence Level 4, part 1: randomized trial, part 2: historically controlled study.

Incidence, Clinical Significance, and Longitudinal Signal Characteristics of Ischemic Lesions Related to Diagnostic Cerebral Catheter Angiography

“…Although a significant benefit in DWI lesion occurrence from patient-specific simulation training the day before DSA has not been demonstrated in a one-time experiment, efforts must be made to optimize training including angiography simulators within a structured curriculum to reduce the modifiable risk of the examiner’s skill level [ 22 ]. In addition, there is evidence of a reduction in DWI lesion load by embolic protection devices such as air filters, but their functional benefit has not been demonstrated to date [ 13 , 23 ].…”

Importance and potential of simulation training in interventional radiology

“…Therefore, there are already clear indications that simulation training by physicians benefits patients. However, direct evidence of a reduction of the already relatively low complication rates is significantly more difficult to provide [35].…”

“…Es gibt also bereits klare Hinweise auf einen Benefit des Patienten vom Simulationstraining des Arztes. Der direkte Nachweis einer Senkung der – ohnehin relativ niedrigen Komplikationsraten – ist dagegen deutlich schwerer zu erbringen 35 .…”

Enhancing Education to Avoid Complications in Endovascular Treatment of Unruptured Intracranial Aneurysms: A Neurointerventionalist’s Perspective

“…Simulation training constitutes a safe environment to practice technical skills. [6][7][8][9][10] Physicians believed that fellows should train as much as possible in a simulation environment to learn basic catheter skills before performing real cases. Standard operating procedures for every procedure step, close adherence to protocols for the management of intraprocedural complications, and choosing the simplest treatment approach possible were additional points physicians considered of high importance.…”