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Sakakura Y, Kono K, Fujimoto T. Real time artificial intelligence assisted carotid artery stenting: a preliminary experience. J Neurointerv Surg 2024:jnis-2024-021600. [PMID: 38580441 DOI: 10.1136/jnis-2024-021600] [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: 02/14/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Neurointerventionalists must pay close attention to multiple devices on multiple screens simultaneously, which can lead to oversights and complications. Artificial intelligence (AI) has potential application in recognizing and monitoring these devices on fluoroscopic imaging. METHODS We report out preliminary experience with a real time AI assistance software, Neuro-Vascular Assist (iMed technologies, Tokyo, Japan), in six patients who underwent carotid artery stenting. This software provides real time assistance during endovascular procedures by tracking wires, guiding catheters, and embolic protection devices. The software provides notification when devices move out of a predefined region of interest or off the screen during the procedure. Efficacy, safety, and accuracy of the software were evaluated. RESULTS The software functioned well without problems and was easily used. Mean number of notifications per procedure was 21.0. The mean numbers of true positives, false positives, and false negatives per procedure were 17.2, 3.8, and 1.2, respectively. Precision and recall were 82% and 94%, respectively. Among the 103 true positive notifications, 24 caused the operator to adjust the inappropriate position of the device (23%), which is approximately four times per procedure. False notifications occurred because of false positive device detection. No adverse events related to the software occurred. No periprocedural complications occurred. CONCLUSIONS Neuro-Vascular Assist, a real time AI assistance software, worked appropriately and may be beneficial in carotid artery stenting procedures. Future large scale studies are warranted to confirm.
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Affiliation(s)
- Yuya Sakakura
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Neurosurgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
- iMed Technologies, Tokyo, Japan
| | - Takeshi Fujimoto
- Department of Neurosurgery, Numata Neurosurgery and Cardiovascular Hospital, Gunma, Japan
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Liu CH, Chang CW, Hung J, Lin JJH, Sung PS, Lee LA, Hsiao CT, Chao YP, Huang ES, Wang SL. Brain computed tomography reading of stroke patients by resident doctors from different medical specialities: An eye-tracking study. J Clin Neurosci 2023; 117:173-180. [PMID: 37837935 DOI: 10.1016/j.jocn.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Using the eye-tracking technique, our work aimed to examine whether difference in clinical background may affect the training outcome of resident doctors' interpretation skills and reading behaviour related to brain computed tomography (CT). METHODS Twelve resident doctors in the neurology, radiology, and emergency departments were recruited. Each participant had to read CT images of the brain for two cases. We evaluated each participant's accuracy of lesion identification. We also used the eye-tracking technique to assess reading behaviour. We recorded dwell times, fixation counts, run counts, and first-run dwell times of target lesions to evaluate visual attention. Transition entropy was applied to assess the temporal relations and spatial dynamics of systematic image reading. RESULTS The eye-tracking results showed that the image reading sequence examined by transition entropy was comparable among resident doctors from different medical specialties (p = 0.82). However, the dwell time of the target lesions was shorter for the resident doctors from the neurology department (4828.63 ms, p = 0.01) than for those from the resident doctors from the radiology (6275.88 ms) and emergency (5305.00 ms) departments. The eye-tracking results in individual areas of interest only showed differences in the eye-tracking performance of the first-run dwell time (p = 0.05) in the anterior cerebral falx. DISCUSSION Our findings demonstrate that resident doctors from different medical specialties may achieve similar imaging reading patterns for brain CT. This may mitigate queries regarding the influence of different backgrounds on training outcomes.
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Affiliation(s)
- Chi-Hung Liu
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Medical Education, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - June Hung
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - John J H Lin
- Graduate Institute of Science Education, National Taiwan Normal University, Taipei City, Taiwan.
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ang Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Ting Hsiao
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan; Department of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Elaine Shinwei Huang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Shu-Ling Wang
- Graduate Institute of Digital Learning and Education, National Taiwan University of Science and Technology, Taiwan
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Otsuka T, Izumi T, Yamamoto M, Seshita Y, Kohama T, Nishihori M, Tsukada T, Saito R. Differences in gaze behaviors between trainees and experts during endovascular therapy for cerebral aneurysms: a preliminary study using a cerebral aneurysm model. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:50-58. [PMID: 36923614 PMCID: PMC10009636 DOI: 10.18999/nagjms.85.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/21/2022] [Indexed: 03/18/2023]
Abstract
In the neuroendovascular field, the training of operators has become an important issue. Recently, eye-tracking technology has been introduced into various fields of medical education. This study aimed to apply eye-tracking technology to the training of neuroendovascular therapy. Six neurosurgeons, including three neuroendovascular specialists and three trainees, at our institution and related facilities participated in the study. Eye movement was recorded by the eye-tracking device during the microcatheter navigation and coil placement into the silastic aneurysm model under biplane X-ray fluoroscopy. Eye-tracking analysis during neuroendovascular therapy was feasible in all six subjects. In microcatheter navigation, specialists tended to more frequently switch their attention between frontal and lateral images than trainees. In coil embolization, the overall gaze frequency tended to increase, and the average fixation duration tended to decrease as the number of experienced cases increased. Inexperienced operators tend to fix their gaze when they are operators than when they are assistants. More experienced operators tended to look at the microcatheter longer in the coil insertion task. The eye-tracking analysis may be useful for operator training in neuroendovascular therapy. Experts may have moved their eyes more frequently than trainees to gaze at the right place. In the future, it will be necessary to collect gaze data for more operators in various tasks.
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Affiliation(s)
- Takafumi Otsuka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Yamamoto
- Department of Electronic Robot Engineering, Aichi University of Technology, Gamagori, Japan
| | - Yusuke Seshita
- Department of Electronic Robot Engineering, Aichi University of Technology, Gamagori, Japan
| | - Takeshi Kohama
- Department of Computational Systems Biology, Faculty of Biology-Oriented Science and Technology, Kindai University,Kinokawa, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Tsukada
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Koizumi S, Shojima M, Dofuku S, Saito A, Nomura S, Ono H, Ishikawa O, Saito N. Neuroendovascular Training Using Multisource Video-Recording System in a Hybrid Operating Room. World Neurosurg 2021; 154:e320-e324. [PMID: 34271148 DOI: 10.1016/j.wneu.2021.07.029] [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: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increasing restrictions over trainees' working hours and the recent coronavirus disease 2019 pandemic warrant new educational methods of surgical skills. We assessed a novel video-recording system for neuroendovascular skill education, developed with the installation of a hybrid operating room (OR) at our institution. METHODS A single-plane angiography unit with a large flat display (FlexVision XL; Philips Medical Systems) was installed in our OR. All media sources in the OR, including live fluoroscopy and ceiling-mounted camcorders, were connected to a video switcher. This video switcher laid up to 8 video images into one big image, which was transferred to the large display and the professional-use Blu-ray recorder. The recording was performed continuously during the procedure. This recording system was evaluated retrospectively with a questionnaire administered to the 5 trainees. RESULTS Using this system, 68 interventional procedures were recorded. Among the potential merits, the trainees assigned the greatest value to the simultaneous recording of the operator's hand motions and the fluoroscopy images. Among the potential limitations of the system, the prolonged time and the increased volume of the video data bothered the trainees the most. The recorded video looked like a live demonstration. CONCLUSIONS Our "selfie" video recording system was useful for skill training of neuroendovascular interventions.
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Affiliation(s)
- Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Masaaki Shojima
- Departmemt of Neurosurgery, Saitama Medical Center, Saitama, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan.
| | - Shogo Dofuku
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Akira Saito
- Departmemt of Neurosurgery, Saitama Medical Center, Saitama, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Seiji Nomura
- Department of Neurosurgery, Yamada Memorial Hospital, Tokyo, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Osamu Ishikawa
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan; Department of Neurosurgery, Asama General Hospital, Nagano, Japan
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Comparing the Visual Perception According to the Performance Using the Eye-Tracking Technology in High-Fidelity Simulation Settings. Behav Sci (Basel) 2021; 11:bs11030031. [PMID: 33807673 PMCID: PMC7998119 DOI: 10.3390/bs11030031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: We used eye-tracking technology to explore the visual perception of clinicians during a high-fidelity simulation scenario. We hypothesized that physicians who were able to successfully manage a critical situation would have a different visual focus compared to those who failed. Methods: A convenience sample of 18 first-year emergency medicine residents were enrolled voluntarily to participate in a high-fidelity scenario involving a patient in shock with a 3rd degree atrioventricular block. Their performance was rated as pass or fail and depended on the proper use of the pacing unit. Participants were wearing pre-calibrated eye-tracking glasses throughout the 9-min scenario and infrared (IR) markers installed in the simulator were used to define various Areas of Interest (AOI). Total View Duration (TVD) and Time to First Fixation (TFF) by the participants were recorded for each AOI and the results were used to produce heat maps. Results: Twelve residents succeeded while six failed the scenario. The TVD for the AOI containing the pacing unit was significantly shorter (median [quartile]) for those who succeeded compared to the ones who failed (42 [31–52] sec vs. 70 [61–90] sec, p = 0.0097). The TFF for the AOI containing the ECG and vital signs monitor was also shorter for the participants who succeeded than for those who failed (22 [6–28] sec vs. 30 [27–77] sec, p = 0.0182). Discussion: There seemed to be a connection between the gaze pattern of residents in a high-fidelity bradycardia simulation and their performance. The participants who succeeded looked at the monitor earlier (diagnosis). They also spent less time fixating the pacing unit, using it promptly to address the bradycardia. This study suggests that eye-tracking technology could be used to explore how visual perception, a key information-gathering element, is tied to decision-making and clinical performance.
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