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Hubbard ZS, Cunningham CM, Saway BF, Weber AC, Sowlat MM, Elawady SS, Nawabi NLA, Porto G, Spiotta AM. Transradial Angiography Skill Acquisition Using an Endovascular Simulation Program. World Neurosurg 2024:S1878-8750(24)01260-9. [PMID: 39033807 DOI: 10.1016/j.wneu.2024.07.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA). METHODS Five neurosurgical residents (PGY 1-3) from our institution enrolled in a standardized pilot training protocol. Trainees used the Mentice (Gothenburg, Vastra Gotaland, Sweden) Visit G5 simulator with a type II arch using a right TRA. RESULTS All participants improved their total time to complete the task from the first trial to the last trial. Residents improved the overall time required to complete the task by 111.8 ± 57 seconds (52% improvement; P = 0.012). Participants reported improved knowledge of Simmons catheter formation from 1.6 ± 0.8 to 2.8 ± 1 (P = 0.035) and improved knowledge of transradial vessel selection technique from 1.6 ± 0.9 to 2.8 ± 1.1 (P = 0.035). All residents were able to illustrate a bovine arch and types 1-3 arches post-simulation. Residents rated the simulation usefulness as 4.6 ± 0.548 (scale 1 [not useful] to 5 [essential]) with 4 of the 5 residents (80%) identifying this exercise as essential. All residents rated the hands-on component of the training exercise as the most important. CONCLUSIONS Residents demonstrated proficiency at Simmons catheter formation and vessel selection in a type II arch over a short time period (4 attempts and <1 hour total). Residents can use simulator-based training to increase their proficiency of vessel selection using a primary or secondary catheter for a TRA.
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Affiliation(s)
- Zachary S Hubbard
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Conor M Cunningham
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Fabian Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aimee C Weber
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Noah LA Nawabi
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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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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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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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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Scullen T, Mathkour M, Maulucci CM, Dumont AS, Bui CJ, Keen JR. Letter to the Editor Impact of the COVID-19 Pandemic on Neurosurgical Residency Training in New Orleans. World Neurosurg 2020; 139:718-719. [PMID: 32380334 PMCID: PMC7198391 DOI: 10.1016/j.wneu.2020.04.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Christopher M Maulucci
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Cuong J Bui
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA
| | - Joseph R Keen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurological Surgery, Ochsner Medical Center, Jefferson, Louisiana, USA.
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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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Nawka MT, Spallek J, Kuhl J, Krause D, Buhk JH, Fiehler J, Frölich A. Evaluation of a modular in vitro neurovascular procedure simulation for intracranial aneurysm embolization. J Neurointerv Surg 2019; 12:214-219. [PMID: 31320551 DOI: 10.1136/neurintsurg-2019-015073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rapid development in endovascular aneurysm therapy continuously drives demand for suitable neurointerventional training opportunities. OBJECTIVE To investigate the value of an integrated modular neurovascular training environment for aneurysm embolization using additively manufactured vascular models. METHODS A large portfolio of 30 patient-specific aneurysm models derived from different treatment settings (eg, coiling, flow diversion, flow disruption) was fabricated using additive manufacturing. Models were integrated into a customizable neurointerventional simulator with interchangeable intracranial and cervical vessel segments and physiological circuit conditions ('HANNES'; Hamburg ANatomic Neurointerventional Endovascular Simulator). Multiple training courses were performed and participant feedback was obtained using a questionnaire. RESULTS Training for aneurysm embolization could be reliably performed using HANNES. Case-specific clinical difficulties, such as difficult aneurysm access or coil dislocation, could be reproduced. During a training session, models could be easily exchanged owing to standardized connectors in order to switch to a different treatment situation or to change from 'treated' back to 'untreated' condition. Among 23 participants evaluating hands-on courses using a five-point scale from 1 (strongly agree) to 5 (strongly disagree), HANNES was mostly rated as 'highly suitable for practicing aneurysm coil embolization' (1.78±0.79). CONCLUSION HANNES offers a wide variability and flexibility for case-specific hands-on training of intracranial aneurysm treatment, providing equal training conditions for each situation. The high degree of standardization offered may be valuable for analysis of device behavior or assessment of physician skills. Moreover, it has the ability to reduce the need for animal experiments.
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Affiliation(s)
- Marie Teresa Nawka
- Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | | | - Juliane Kuhl
- Technical University Hamburg-Harburg, Hamburg, Germany
| | - Dieter Krause
- Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany.,Technical University Hamburg-Harburg, Hamburg, Germany
| | - Jan Hendrik Buhk
- Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | - Jens Fiehler
- Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | - Andreas Frölich
- Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
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Christophel JJ, Park SS, Nogan SJ, Essig GF. A Facial Trauma Simulation Course for Evaluation and Treatment of Facial Fractures. JAMA FACIAL PLAST SU 2017; 19:464-467. [PMID: 28594983 DOI: 10.1001/jamafacial.2017.0313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Traditional facial trauma laboratories are used for teaching basic concepts of fracture reduction and hardware manipulation. Facial trauma simulation laboratories allow training physicians the opportunity to develop unique treatment plans as they would in real patient encounters. Objective To assess the value of a novel facial trauma simulation course requiring residents to practice advanced decision making. Design, Setting, and Participants Data were prospectively collected July 23 and August 23 and 24, 2016, in a survey study during a resident physician trauma simulation course. Fresh frozen cadaver heads were fractured using an impactor that applied a measurable amount of force. Each head was scanned with high-resolution computed tomography. Residents were paired and tasked with evaluating their specimen's imaging findings and developing a treatment plan. Main Outcomes and Measures Before the course, residents were asked their postgraduate year level, number of facial fractures treated as a resident surgeon, and their comfort level based on the Otolaryngology Milestone for Facial Trauma (OMFT; ratings range from 0-5, with 5 indicating equivalent to fellow-level experience). After the course, residents were asked to assess the course's value relative to a theoretical number of actual operative cases, and a posttraining OMFT assessment was obtained. Results Thirty resident physicians completed the course at 2 institutions. Residents represented an equivalent distribution of postgraduate year levels. The residents stated that the course was worth a mean (SD) of 6.4 (2.8) operative cases of facial trauma in terms of surgical learning. The mean change in self-reported OMFT rating after the course was 0.87 (95% CI, 0.67-1.07; P < .001, paired t test). On the basis of this change in self-perceived OMFT rating, the course was deemed to be worth 1.5 years of residency training in the management of facial fractures. Conclusion and Relevance Conducting a facial trauma simulation course increases resident experience with advanced surgical decision making. Level of Evidence NA.
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Affiliation(s)
- J Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville
| | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville
| | - Stephen J Nogan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Garth F Essig
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
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Arthur A, Hoit D, Coon A, Delgado Almandoz JE, Elijovich L, Cekirge S, Fiorella D. Physician training protocol within the WEB Intrasaccular Therapy (WEB-IT) study. J Neurointerv Surg 2017; 10:500-504. [PMID: 28814528 DOI: 10.1136/neurintsurg-2017-013310] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The WEB Intra-saccular Therapy (WEB-IT) trial is an investigational device exemption study to demonstrate the safety and effectiveness of the WEB device for the treatment of wide-neck bifurcation aneurysms. The neurovascular replicator (Vascular Simulations, Stony Brook, New York, USA) creates a physical environment that replicates patient-specific neurovascular anatomy and hemodynamic physiology, and allows devices to be implanted under fluoroscopic guidance. OBJECTIVE To report the results of a unique neurovascular replicator-based training program, which was incorporated into the WEB-IT study to optimize technical performance and patient safety. METHODS US investigators participated in a new training program that incorporated full surgical rehearsals on a neurovascular replicator. No roll-in cases were permitted within the trial. Custom replicas of patient-specific neurovascular anatomy were created for the initial cases treated at each center, as well as for cases expected to be challenging. On-site surgical rehearsals were performed before these procedures. RESULTS A total of 48 participating investigators at 25 US centers trained using the replicator. Sessions included centralized introductory training, on-site training, and patient-specific full surgical rehearsal. Fluoroscopy and procedure times in the WEB-IT study were not significantly different from those seen in two European trials where participating physicians had significant WEB procedure experience before study initiation. CONCLUSIONS A new program of neurovascular-replicator-based physician training was employed within the WEB-IT study. This represents a new methodology for education and training that may be an effective means to optimize technical success and patient safety during the introduction of a new technology.
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Affiliation(s)
- Adam Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel Hoit
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Alexander Coon
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Josser E Delgado Almandoz
- Department of Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Lucas Elijovich
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Saruhan Cekirge
- Marmara University Faculty of Medicine, Pendik Training and Research Hospital, Istanbul, Turkey
| | - David Fiorella
- Department of Neurosurgery, State University of New York, Stony Brook, New York, USA
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Zhang L, Kamaly I, Luthra P, Whitfield P. Simulation in neurosurgical training: a blueprint and national approach to implementation for initial years trainees. Br J Neurosurg 2016; 30:577-81. [PMID: 27601027 DOI: 10.1080/02688697.2016.1211252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Simulation has played an increasing role in surgical training in recent years, this follows from various reports such as the Chief Medical Officer annual report and Sir John Temple's 'Time for Training' and also from other factors such as increasing focus on efficiency and transparency within the healthcare system. Evidence has shown that simulation can develop and improve technical, clinical, communication and management skills. With technological advances, the quality of simulation has also improved with more realistic models and environment. We have undertaken a review of recent drivers for simulation training in the UK, current techniques and have focused on the application of simulation training within the current UK Neurosurgical curriculum for newly appointed trainees.
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Affiliation(s)
- Lihan Zhang
- a Derriford Hospital, Plymouth Hospitals NHS Trust , Plymouth , UK
| | - Ian Kamaly
- b Central Manchester University Hospitals NHS Foundation Trust , Manchester , UK
| | | | - Peter Whitfield
- a Derriford Hospital, Plymouth Hospitals NHS Trust , Plymouth , UK
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