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  4. Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation.
 
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Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation.
File(s)
Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation.pdf (1.58 MB)
Published version
Author(s)
Mazomenos, EB
Chang, PL
Rippel, RA
Rolls, A
Hawkes, DJ
more
Type
Journal Article
Abstract
PURPOSE: Transcatheter aortic valve implantation (TAVI) demands precise and efficient handling of surgical instruments within the confines of the aortic anatomy. Operational performance and dexterous skills are critical for patient safety, and objective methods are assessed with a number of manipulation features, derived from the kinematic analysis of the catheter/guidewire in fluoroscopy video sequences. METHODS: A silicon phantom model of a type I aortic arch was used for this study. Twelve endovascular surgeons, divided into two experience groups, experts ([Formula: see text]) and novices ([Formula: see text]), performed cannulation of the aorta, representative of valve placement in TAVI. Each participant completed two TAVI experiments, one with conventional catheters and one with the Magellan robotic platform. Video sequences of the fluoroscopic monitor were recorded for procedural processing. A semi-automated tracking software provided the 2D coordinates of the catheter/guidewire tip. In addition, the aorta phantom was segmented in the videos and the shape of the entire catheter was manually annotated in a subset of the available video frames using crowdsourcing. The TAVI procedure was divided into two stages, and various metrics, representative of the catheter's overall navigation as well as its relative movement to the vessel wall, were developed. RESULTS: Experts consistently exhibited lower values of procedure time and dimensionless jerk, and higher average speed and acceleration than novices. Robotic navigation resulted in increased average distance to the vessel wall in both groups, a surrogate measure of safety and reduced risk of embolisation. Discrimination of experience level and types of equipment was achieved with the generated motion features and established clustering algorithms. CONCLUSIONS: Evaluation of surgical skills is possible through the analysis of the catheter/guidewire motion pattern. The use of robotic endovascular platforms seems to enable more precise and controlled catheter navigation.
Date Issued
2016-04-12
Date Acceptance
2016-03-16
Citation
International Journal of Computer Assisted Radiology and Surgery, 2016, 11 (6), pp.1121-1131
URI
http://hdl.handle.net/10044/1/33578
DOI
https://www.dx.doi.org/10.1007/s11548-016-1391-6
ISSN
1861-6410
Publisher
Springer Verlag (Germany)
Start Page
1121
End Page
1131
Journal / Book Title
International Journal of Computer Assisted Radiology and Surgery
Volume
11
Issue
6
Copyright Statement
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
http://www.ncbi.nlm.nih.gov/pubmed/27072837
PII: 10.1007/s11548-016-1391-6
Grant Number
RDB04 79560
RD207
Subjects
Catheter motion analysis
Endovascular robotics
Objective skills assessment
Nuclear Medicine & Medical Imaging
Clinical Sciences
Publication Status
Published
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