virtX – Evaluation of a Computer-based Training System for Mobile C-arm Systems in Trauma and Orthopedic Surgery

Abstract

Summary Objectives: Operating room personnel (ORP) operating mobile image intensifier systems (C-arms) need training to produce high quality radiographs with a minimum of time and X-ray exposure. Our study aims at evaluating acceptance, usability and learning effect of the CBT system virtX that simulates C-arm based X-ray imaging in the context of surgical case scenarios. Methods: Prospective, interventional study conducted during an ORP course with three groups: intervention group 1 (training on a PC using virtX), and 2 (virtX with a C-arm as input device), and a control group (training without virtX) – IV1, IV2 and CG. All participants finished training with the same exercise. Time needed to produce an image of sufficient quality was recorded and analyzed using One-Way-ANOVA and Dunnett post hoc test (? = .05). Acceptance and usability of virtX have been evaluated using a questionnaire. Results: CG members (n = 21) needed more time for the exercise than those of IV2 (n = 20): 133 ± 55 vs. 101 ± 37 sec. (p = .03). IV1 (n = 12) also performed better than CG (128 ± 48 sec.), but this was not statistically significant. Seventy-nine participants returned a questionnaire (81% female, age 34 ± 9 years, professional experience 8.3 ± 7.6 years; 77% regularly used a C-arm). 83% considered virtX a useful addition to conventional C-arm training. 91% assessed virtual radiography as helpful for understanding C-arm operation. Conclusions: Trainees experienced virtX as substantial enhancement of C-arm training. Training with virtX can reduce the time needed to perform an imaging task.

Evaluation of the Use of Artificial X-Rays for Educational and Intraoperative Guidance During C-Arm Positioning

“…Our finding of no significant change in task time with AXIS is somewhat different compared with findings for the virtX system (24% decrease) and the zero-dose navigation system (68% increase) (Bott 2008, Müller 2011. Carm positioning accuracy was not reported for these related systems.…”

“…Others have used artificial X-rays for simulation training (Bott 2008, Gong 2014, Cleary 2004. Though the intent is to improve C-arm positioning accuracy and efficiency during orthopaedic procedures, these systems have primarily been evaluated on system accuracy and not on their potential to decrease radiation exposure inside the OR or C-arm positioning time.…”