Neuroangiography simulation using a silicone model in the angiography suite improves trainee skills
ABSTRACT Simulation techniques in neurosurgical training are becoming more important. The purpose of this study was to determine whether silicone vascular models used in the angiography suite can render improvement in trainee performance and safety in neuroendovascular procedures.
10 residents from neurosurgery and radiology training programs were asked to perform a diagnostic angiogram on a silicone based vascular model (United Biologics, Tustin, USA). This was done in the angiography suite with the full biplane fluoroscopy machine (Siemens, Munich, Germany). On their first attempt, they were coached by a faculty member trained in endovascular neurosurgery; on their second attempt, they received coaching only if the procedure had stalled. Technique was scored on multiple criteria by the faculty, and total time and fluoroscopy time were recorded on both attempts.
In this group of 10 residents, overall procedure time significantly decreased from 51 to 42 min (p=0.01), and total fluoro time significantly decreased from 12 to 9 min (p=0.002) between the first attempt and the second attempt. Technical skill increased significantly in navigation, vessel selection, projection setup, and road map usage.
Silicone vascular models used in the angiography suite, with the clinical working tools and biplane fluoroscopy, provide a valuable experience for training residents in diagnostic angiography, and improved performance and safety.
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ABSTRACT: To assess the construct validity of the Procedicus Virtual Interventional Simulator Trainer (Procedicus-VIST) and its use as a training tool. Two groups comprised of 8 interventional radiologists (experts) and 8 medical students (novices) performed 6 renal artery procedures on the Procedicus-VIST. All participants received a 45-minute standardized didactic introduction before starting the simulations. The first 2-hour session was used for familiarization, whereas the second session constituted the testing period. During each procedure, objective performance data including procedure time, fluoroscopic time, contrast, cine loops, lesion coverage, tool:lesion ratio, placement accuracy, and residual stenosis were recorded by the Procedicus-VIST software. Exit surveys were completed to document demographic and subjective data. A visual analogue scale (VAS) from 0 to 100 was used to rate total, guidewire, catheter, balloon, stent, fluoroscopic, and joystick realism, as well as the simulator's pedagogic value. There were no significant differences in performances between the 2 groups in residual stenosis, placement accuracy, procedure time, number of cine loops, lesion coverage, or tool:lesion ratio. The total fluoroscopic use was greater for the novice group (p < 0.01). Experts rated 6 of the 8 subjective parameters favorably, whereas the novice group approved of 7. Using this study design, the quantitative metrics recorded by the Procedicus-VIST software failed to stratify performances based upon experience level, with the exception of fluoroscopic use. Investigation comparing standard training to virtual reality training should be performed to assess any differences in actual performance in the catheterization laboratory.Journal of Endovascular Therapy 05/2006; 13(2):237-43. DOI:10.1583/05-1729.1 · 3.59 Impact Factor
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ABSTRACT: The use of simulators in medical training has been on the rise over the past decade as a means to teach procedural skills to trainees in a risk free environment. The goal of this study was to pilot a simulator based skills course for inexperienced neurosurgical residents to teach the fundamentals of cervicocerebral catheterization and angiography, with the ultimate goal of defining a universal simulator based curriculum that could be incorporated into neurosurgical resident training in the future. Seven neurosurgery residents with no prior angiographic experience served as the pilot participants for this 2 day course. Four neurointerventional trained neurosurgeons served as faculty for instruction and evaluation. The majority of the course focused on hands-on simulator practice with close mentoring by faculty. Participants were evaluated with pre-course and post-course assessments. Post-course written test scores were significantly higher than pre-course scores (p<0.001). Faculty assessments of participants' technical skills with angiography (graded 0-10, with 10 being best) also improved significantly from pre-course to post-course (pre 2.1; post 5.9; p<0.001). Objective simulator recorded assessments demonstrated a significant decrease in the time needed to complete a four vessel angiogram (p<0.001) and total fluoroscopic time (p<0.001). Participant angiography skills, based on both faculty and simulator assessments, as well as participant knowledge, improved after this didactic, hands-on simulator course. Neuroendovascular simulator training appears to be a viable means of training inexperienced neurosurgery residents in the early learning stages of basic endovascular neurosurgery. Further studies evaluating the translation of procedural skills learned on the simulator to actual clinical skills in the angiography suite is necessary.Journal of Neurointerventional Surgery 10/2011; 4(6):438-41. DOI:10.1136/neurintsurg-2011-010128 · 1.38 Impact Factor