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Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. ROFO-FORTSCHR RONTG 2023; 195:883-889. [PMID: 37137320 DOI: 10.1055/a-2066-8009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Simulation training is a common method in many medical disciplines and is used to teach content knowledge, manual skills, and team skills without potential patient danger. METHODS Simulation models and methods in interventional radiology are explained. Strengths and weaknesses of both simulators for non-vascular and vascular radiological interventions are highlighted and necessary future developments are addressed. RESULTS Both custom-made and commercially available phantoms are available for non-vascular interventions. Interventions are performed under ultrasound guidance, with computed tomography assistance, or using mixed-reality methods. The wear and tear of physical phantoms can be countered with in-house production of 3D-printed models. Vascular interventions can be trained on silicone models or hightech simulators. Increasingly, patient-specific anatomies are replicated and simulated pre-intervention. The level of evidence of all procedures is low. CONCLUSION Numerous simulation methods are available in interventional radiology. Training on silicone models and hightech simulators for vascular interventions has the potential to reduce procedural time. This is associated with reduced radiation dose for both patient and physician, which can also contribute to improved patient outcome, at least in endovascular stroke treatment. Although a higher level of evidence should be achieved, simulation training should already be integrated into the guidelines of the professional societies and accordingly into the curricula of the radiology departments. KEY POINTS · There are numerous simulation methods for nonvascular and vascular radiologic interventions.. · Puncture models can be purchased commercially or made using 3D printing.. · Silicone models and hightech simulators allow patient-specific training.. · Simulation training reduces intervention time, benefiting both the patient and the physician.. · A higher level of evidence is possible via proof of reduced procedural times.. CITATION FORMAT · Kreiser K, Sollmann N, Renz M. Importance and potential of simulation training in interventional radiology. Fortschr Röntgenstr 2023; 195: 883 - 889.
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Affiliation(s)
- Kornelia Kreiser
- RKU, Department of Neuroradiology, University Hospital Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Martin Renz
- Departement of Diagnostic and Interventional Neuroradiology, Technical University of Munich Hospital Rechts der Isar, Munchen, Germany
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Patient-Specific 3D-Print Extracranial Vascular Simulators and Infrared Imaging Platform for Diagnostic Cerebral Angiography Training. Healthcare (Basel) 2022; 10:healthcare10112277. [DOI: 10.3390/healthcare10112277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Tortuous aortic arch is always challenging for beginner neuro-interventionalists. Herein, we share our experience of using 3D-printed extracranial vascular simulators (VSs) and the infrared imaging platform (IRIP) in two training courses for diagnostic cerebral angiography in the past 4 years. A total of four full-scale patient-specific carotid-aortic-iliac models were fabricated, including one type I arch, one bovine variant, and two type III arches. With an angiography machine (AM) as the imaging platform for the practice and final test, the first course was held in March 2018 had 10 participants, including three first-year residents (R1), three second-year residents (R2), and four third-year residents (R3). With introduction of the IRIP as the imaging platform for practice, the second course in March 2022 had nine participants, including 3 R1s, 3 R2s, and 3 R3s. The total manipulation time (TMT) to complete type III aortic arch navigation was recorded. In the first course, the average TMT of the first trial was 13.1 min. Among 3 R1s and 3 R2s attending the second trial, the average TMT of the second trial was 3.4 min less than that of the first trial. In the second course using IRIP, the average TMT of the first and second trials was 6.7 min and 4.8 min, respectively. The TMT of the second trial (range 2.2~14.4 min; median 5.9 min) was significantly shorter than that of the first trial (range 3.6~18 min; median 8.7 min), regardless of whether AM or IRIP was used (p = 0.001). Compared with first trial, the TMT of the second trial was reduced by an average of 3.7 min for 6 R1s, which was significantly greater than the 1.7 min of R2 and R3 (p = 0.049). Patient-specific VSs with radiation-free IRIP could be a useful training platform for junior residents with little experience in neuroangiography.
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Gopesh T, Wen JH, Santiago-Dieppa D, Yan B, Scott Pannell J, Khalessi A, Norbash A, Friend J. Soft robotic steerable microcatheter for the endovascular treatment of cerebral disorders. Sci Robot 2021; 6:6/57/eabf0601. [PMID: 34408094 PMCID: PMC9809155 DOI: 10.1126/scirobotics.abf0601] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/26/2021] [Indexed: 01/05/2023]
Abstract
Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the microcatheters through tortuous vasculature to access aneurysms. We overcome this problem with submillimeter diameter, hydraulically actuated hyperelastic polymer devices at the distal tip of microcatheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using saline as a working fluid, we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.
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Affiliation(s)
- Tilvawala Gopesh
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA
| | - Jessica H. Wen
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA
| | | | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J. Scott Pannell
- Department of Neurosurgery, University of California San Diego, USA
| | | | | | - James Friend
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA,Department of Surgery, University of California San Diego, USA,To whom correspondence should be addressed; , Medically Advanced Devices Laboratory, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Scullen T, Mathkour M, Dumont A. Commentary: Virtual Reality Anterior Cervical Discectomy and Fusion Simulation on the Novel Sim-Ortho Platform: Validation Studies. Oper Neurosurg (Hagerstown) 2020; 20:E17-E19. [PMID: 32970133 DOI: 10.1093/ons/opaa285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/11/2020] [Indexed: 11/13/2022] Open
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Gough M, Solomou G, Khan DZ, Kamel M, Fountain D, Kumaria A, Ashpole R, Sinha S, Mendoza N. The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data. Acta Neurochir (Wien) 2020; 162:2323-2334. [PMID: 32358655 PMCID: PMC7496022 DOI: 10.1007/s00701-020-04325-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/02/2020] [Indexed: 11/22/2022]
Abstract
Background The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment. Methods A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop. Two assessors used a novel modified Objective Structured Assessment of Technical Skills (mOSATS) assessment tool, comprising 5 domains ranked according to a 5-point scale to rate delegates’ ability to create a burr hole. Qualitative data from previous workshops were collected, consisting of open-ended, closed-ended and 5-point Likert scale responses to pre- and post-workshop questionnaires. Data were analysed using SPSS® software. Results Delegates scored a mean total of 62.1% (21.75/35) and 85.1% (29.8/35) in pre- and post-workshop assessments respectively revealing a statistically significant improvement. Regarding percentage of improvement, no significant difference was shown amongst candidates when comparing the number of neurosurgical cases observed and/or assisted in the past. There was no significant difference in the overall rating between the last two workshops (4.89 and 4.8 out of 5, respectively). One hundred percent of the attendees reported feeling more confident in assisting in theatre after the last two workshops. Conclusion We show that a simulation workshop cannot only objectively quantify the improvement of surgical skill acquisition but can also be beneficial regardless of the extent of prior experience.
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Scullen T, Nerva JD, Amenta PS, Dumont AS. Commentary: Design and Physical Properties of 3-Dimensional Printed Models Used for Neurointervention: A Systematic Review of the Literature. Neurosurgery 2020; 87:E454-E455. [PMID: 32453826 DOI: 10.1093/neuros/nyaa217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
| | - John D Nerva
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
| | - Peter S Amenta
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana
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Yamaki VN, Cancelliere NM, Nicholson P, Rodrigues M, Radovanovic I, Sungur JM, Krings T, Pereira VM. Biomodex patient-specific brain aneurysm models: the value of simulation for first in-human experiences using new devices and robotics. J Neurointerv Surg 2020; 13:272-277. [PMID: 32601259 PMCID: PMC7892376 DOI: 10.1136/neurintsurg-2020-015990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
Background With the recent advent of advanced technologies in the field, treatment of neurovascular diseases using endovascular techniques is rapidly evolving. Here we describe our experience with pre-surgical simulation using the Biomodex EVIAS patient-specific 3D-printed models to plan aneurysm treatment using endovascular robotics and novel flow diverter devices. Methods Pre-procedural rehearsals with 3D-printed patient-specific models of eight cases harboring brain aneurysms were performed before the first in-human experiences. To assess the reliability of the experimental model, the characteristics of the aneurysms were compared between the patient and 3D models. The rehearsals were used to define the patient treatment plan, including technique, device sizing, and operative working projections. Results The study included eight patients with their respective EVIAS 3D aneurysm models. Pre-operative simulation was performed for the first in-human robotic-assisted neurovascular interventions (n=2) and new generation flow-diverter stents (n=6). Aneurysms were located in both the anterior (n=5) and posterior (n=3) circulation and were on average 11.0±6.5 mm in size. We found reliable reproduction of the aneurysm features and similar dimensions of the parent vessel anatomy between the 3D models and patient anatomy. Information learned from pre-surgical in vitro simulation are described in detail, including an improved patient treatment plan, which contributed to successful first in-world procedures with no intraprocedural complications. Conclusions Pre-procedural rehearsal using patient-specific 3D models provides precise procedure planning, which can potentially lead to greater operator confidence, decreased radiation dose and improvements in patient safety, particularly in first in-human experiences.
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Affiliation(s)
- Vitor Nagai Yamaki
- Division of Neurosurgery, Department of Neurology, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Patrick Nicholson
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marta Rodrigues
- Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Ivan Radovanovic
- Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Timo Krings
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic Review of Simulation-Based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills. World Neurosurg 2020; 133:e874-e892. [DOI: 10.1016/j.wneu.2019.08.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
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Sullivan S, Aguilar-Salinas P, Santos R, Beier AD, Hanel RA. Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report. J Neurosurg Pediatr 2018; 22:672-677. [PMID: 30215588 DOI: 10.3171/2018.6.peds17696] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/13/2018] [Indexed: 11/06/2022]
Abstract
The use of simulators has been described in a variety of fields as a training tool to gain technical skills through repeating and rehearsing procedures in a safe environment. In cerebrovascular surgery, simulation of skull base approaches has been used for decades. The use of simulation in neurointervention to acquire and enhance skills before treating a patient is a newer concept, but its utilization has been limited due to the lack of good models and deficient haptics. The advent of 3D printing technology and the development of new training models has changed this landscape. The prevalence of aneurysms in the pediatric population is much lower than in adults, and concepts and tools sometimes have to be adapted from one population to another. Neuroendovascular rehearsal is a valid strategy for the treatment of complex aneurysms, especially for the pediatric population. The authors present the case of an 8-year-old boy with a fusiform intracranial aneurysm and documented progressive growth, who was successfully treated after the authors rehearsed the placement of a flow diverter using a patient-specific 3D-printed replicator system model.
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Affiliation(s)
- Sean Sullivan
- 1Lyerly Neurosurgery, Baptist Neurological Institute; and
| | | | - Roberta Santos
- 1Lyerly Neurosurgery, Baptist Neurological Institute; and
| | - Alexandra D Beier
- 2Division of Pediatric Neurosurgery, University of Florida Health Science Center, Jacksonville, Florida
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Yang I, Udawatta M, Prashant GN, Lagman C, Bloch O, Jensen R, Sheehan J, Kalkanis S, Warnick R. Stereotactic Radiosurgery for Neurosurgical Patients: A Historical Review and Current Perspectives. World Neurosurg 2018; 122:522-531. [PMID: 30399473 DOI: 10.1016/j.wneu.2018.10.193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/09/2022]
Abstract
Today, stereotactic radiosurgery is an effective therapy for a variety of intracranial pathology that were treated solely with open neurosurgery in the past. The technique was developed from the combination of therapeutic radiation and stereotactic devices for the precise localization of intracranial targets. Although stereotactic radiosurgery was originally performed as a partnership between neurosurgeons and radiation oncologists, this partnership has weakened in recent years, with some procedures being performed without neurosurgeons. At the same time, neurosurgeons across the United States and Canada have found their stereotactic radiosurgery training during residency inadequate. Although neurosurgeons, residency directors, and department chairs agree that stereotactic radiosurgery education and exposure during neurosurgery training could be improved, a limited number of resources exist for this kind of education. This review describes the history of stereotactic radiosurgery, assesses the state of its use and education today, and provides recommendations for the improvement of neurosurgical education in stereotactic radiosurgery for the future.
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Affiliation(s)
- Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Office of the Patient Experience, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, Torrance, California, USA.
| | - Methma Udawatta
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Giyarpuram N Prashant
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Carlito Lagman
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Randy Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Steven Kalkanis
- Department of Neurosurgery, Hermelin Brain Tumor Center, Henry Ford Health System, Detroit, Michigan, USA
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Assessment of Competence in EVAR Stent Graft Sizing and Selection. Eur J Vasc Endovasc Surg 2017; 53:844-852. [DOI: 10.1016/j.ejvs.2017.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/07/2017] [Indexed: 12/20/2022]
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Quantitative Evaluation of Performance in Interventional Neuroradiology: An Integrated Curriculum Featuring Theoretical and Practical Challenges. PLoS One 2016; 11:e0148694. [PMID: 26848840 PMCID: PMC4743848 DOI: 10.1371/journal.pone.0148694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose We sought to develop a standardized curriculum capable of assessing key competencies in Interventional Neuroradiology by the use of models and simulators in an objective, quantitative, and efficient way. In this evaluation we analyzed the associations between the practical experience, theoretical knowledge, and the skills lab performance of interventionalists. Materials and Methods We evaluated the endovascular skills of 26 participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology with a set of three tasks (aneurysm coiling and thrombectomy in a virtual simulator and placement of an intra-aneurysmal flow disruptor in a flow model). Practical experience was assessed by a survey. Participants completed a written and oral examination to evaluate theoretical knowledge. Bivariate and multivariate analyses were performed. Results In multivariate analysis knowledge of materials and techniques in Interventional Neuroradiology was moderately associated with skills in aneurysm coiling and thrombectomy. Experience in mechanical thrombectomy was moderately associated with thrombectomy skills, while age was negatively associated with thrombectomy skills. We found no significant association between age, sex, or work experience and skills in aneurysm coiling. Conclusion Our study gives an example of how an integrated curriculum for reasonable and cost-effective assessment of key competences of an interventional neuroradiologist could look. In addition to traditional assessment of theoretical knowledge practical skills are measured by the use of endovascular simulators yielding objective, quantitative, and constructive data for the evaluation of the current performance status of participants as well as the evolution of their technical competency over time.
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