Using computerized assessment in simulated colonoscopy: a validation study

Abstract

Background and study aims Patient safety during a colonoscopy highly depends on endoscopist competence. Endoscopic societies have been calling for an objective and regular assessment of the endoscopists, but existing assessment tools are time-consuming and prone to bias. We aimed to develop and gather evidence of validity for a computerized assessment tool delivering automatic and unbiased assessment of colonoscopy based on 3 dimensional coordinates from the colonoscope. Methods Twenty-four participants were recruited and divided into two groups based on experience: 12 experienced and 12 novices. Participants performed twice on a physical phantom model with a standardized alpha loop in the sigmoid colon. Data was gathered directly from the Olympus ScopeGuide system providing XYZ-coordinates along the length of the colonoscope. Five different motor skill measures were developed based on the data, named: Travel Length, Tip Progression, Chase Efficiency, Shaft movement without tip progression, and Looping. Results The experinced had a lower travel length (P < 0.001), tip progression (P < 0.001), chase efficiency (P = 0.001) and looping (P = 0.006), and a higher shaft movement without tip progression (P < 0.001) reaching the cecum compared with the novices. A composite score was developed based on the five measurements to create a combined score of progression, the 3D-Colonoscopy-Progression-Score (3D-CoPS). The 3D-CoPS revealed a significant difference between groups (experienced: 0.495 (SD 0.303) and novices –0.454 (SD 0.707), P < 0.001). Conclusion This study presents a novel, real-time computerized assessment tool for colonoscopy, and strong evidence of validity was gathered in a simulation-based setting. The system shows promising opportunities for automatic, unbiased and continuous assessment of colonoscopy performance.

Expertise in colonoscopy intubation does not predict diagnostic accuracy: a simulation-based study

“…Looping is quantification of how looped the colonoscope is during the procedure. The five measurements were built into a composite score, the 3D-CoPS, which is a computerized assessment tool that was developed to assess the technical performance of the progression from anus to cecum [6].…”

“…CIR is a retrospective measure that requires a large number of performed procedures to be a valid quality measure and DOPS is time-consuming for assessors and prone to observer bias. The 3D-Colonoscopy Progression Score (3D-CoPS), however, is a newly developed computerized assessment tool able to assess intubation skills automatically Expertise in colonoscopy intubation does not predict diagnostic accuracy: a simulation-based study and in an unbiased fashion, which was developed to overcome the downsides of current tools available, making it ideal [6].…”

Methods for Gastrointestinal Endoscopy Quantification: A Focus on Hands and Fingers Kinematics

“…Motion quantification in endoscope procedures has considered two different objects: endoscope and endoscopist. Regarding endoscope movements, there are several studies [ 20 , 22 , 25 , 31 , 33 ] that attempt to quantify features such as longitudinal and circular displacement of the endoscope along the larger intestine, tip angulation, angular velocity, and rotation [ 22 , 25 , 31 ].…”

Analyzing colonoscopy training learning curves using comparative hand tracking assessment

“…Vilmann et al used the Olympus ScopeGuide system, which comprises a colonoscope with electromagnetic (EM) coils built into the scope along its length, and a tracking device. They compared novices and experts on their path lengths 12 . Obstein et al affixed 6 EM sensors along the exterior of the scope at regular intervals 13 .…”