Virtual reality, ultrasound-guided liver biopsy simulator: development and performance discrimination

Abstract

Objectives: The aim of this article was to identify and prospectively investigate simulated ultrasound-guided targeted liver biopsy performance metrics as differentiators between levels of expertise in interventional radiology. Methods: Task analysis produced detailed procedural step documentation allowing identification of critical procedure steps and performance metrics for use in a virtual reality ultrasound-guided targeted liver biopsy procedure. Consultant (n514; male511, female53) and trainee (n526; male519, female57) scores on the performance metrics were compared. Ethical approval was granted by the Liverpool Research Ethics Committee (UK). Independent t-tests and analysis of variance (ANOVA) investigated differences between groups. Results: Independent t-tests revealed significant differences between trainees and consultants on three performance metrics: targeting, p50.018, t522.487 (22.040 to 20.207); probe usage time, p50.040, t52.132 (11.064 to 427.983); mean needle length in beam, p50.029, t522.272 (20.028 to 20.002). ANOVA reported significant differences across years of experience (0-1, 1-2, 3+ years) on seven performance metrics: no-go area touched, p50.012; targeting, p50.025; length of session, p50.024; probe usage time, p50.025; total needle distance moved, p50.038; number of skin contacts, p,0.001; total time in no-go area, p50.008. More experienced participants consistently received better performance scores on all 19 performance metrics. Conclusion: It is possible to measure and monitor performance using simulation, with performance metrics providing feedback on skill level and differentiating levels of expertise. However, a transfer of training study is required.

Interventional radiology virtual simulator for liver biopsy

“…Studies of the effectiveness of the simulation have been performed in collaboration with interventional clinicians and include content validation where end-user feedback was positive. Construct validity was demonstrated with experts performing significantly better than trainees on a number of performance metrics [8]. It was concluded that it is possible to measure and monitor performance using simulation, with performance metrics providing feedback on skill level in relation to specific aspects of the procedure.…”

“…Following development of the simulator and implementation of the performance metrics, a validation study of the liver biopsy procedure was conducted [8]. Participants with varying degrees of expertise in interventional radiology completed the simulated liver biopsy procedure and the utility of the performance metrics as differentiators between levels of expertise in Interventional Radiology was investigated.…”

“…The simulation's metrics evaluate relevant steps of the trainee's performance. The simulator has been validated in radiology departments, with interventional radiologists with different levels of expertise to assess its face, content and construct validity [8].…”

Simulation: Moving from Technology Challenge to Human Factors Success

“…For relevance to assessments, the most critical steps of the procedure require evaluation. Recent recognition of the importance of identifying these specific task steps that reflect proficiency, and the performance metrics that can measure them, stands to reaffirm the relevance of automated assessment tools to training and credentialing [21,23,24].…”

Homemade ultrasound phantom for simulation of hydronephrosis

“…Thus, the use of simulation phantoms present students with not only the possibility of obtaining competence in identifying pathologies such as renal pelvis dilatation by an obstructive process, but also allows the familiarization with the US machine in order to obtain images of good quality. [7][8][9][10][11] In this paper, we describe a homemade, low cost, and quickly assembled phantom to be used as surrogate for training medical students and residents in the ultrasonographic identification of hydronephrosis.…”