A radiation-free mixed-reality training environment and assessment concept for C-arm-based surgery
A radiation-free mixed-reality training environment and assessment concept for C-arm-based surgery
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DOI：
10.1007/s11548-018-1807-6
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发表时间：
2018-09-01
影响因子：
3
通讯作者：
Navab, Nassir
中科院分区：
文献类型：
--
作者：
Stefan, Philipp;Habert, Severine;Navab, Nassir
目的临床培训和评估机会的不断减少和外科干预措施的日益复杂导致了不同的培训和评估选项的发展，如解剖模型、基于计算机的模拟器或身体培训。然而，在培训、评估和最终完成患者治疗之后，学员仍然面临着陡峭的学习曲线。方法为了解决基于C臂的手术的这个问题，我们介绍了一个逼真的无辐射模拟系统，它结合了基于患者的3D打印解剖和使用物理C臂的模拟X射线成像。为了探索混合现实系统在训练和评估中的逼真度和实用性，我们与6名外科专家在模拟器上进行了小关节注射的用户研究。结果在技术评估中，我们的系统模拟X射线图像的均方根误差为1.85 mm，与真实X射线成像相比，RMSE为1.85 mm。与会者表示同意模拟的总体现实性、评估系统的有用性，并强烈同意这种混合现实系统对新手和专家的培训的有用性。在定量分析中，我们进一步评估了该系统用于手术技能评估的适宜性，并收集了初步的有效性证据。结论提出的混合现实模拟系统促进了向基于C臂的手术的过渡，具有补充甚至取代大部分身体训练的潜力，提供了一个安全的评估环境，并降低了患者治疗过程中出错的风险。我们提出了评估的概念，并概述了将该系统扩展为一种测试工具所需的步骤，该测试工具提供了可靠和合理的评估分数，表明手术熟练程度，并有足够的证据证明其有效性。
PurposeThe discrepancy of continuously decreasing opportunities for clinical training and assessment and the increasing complexity of interventions in surgery has led to the development of different training and assessment options like anatomical models, computer-based simulators or cadaver trainings. However, trainees, following training, assessment and ultimately performing patient treatment, still face a steep learning curve.MethodsTo address this problem for C-arm-based surgery, we introduce a realistic radiation-free simulation system that combines patient-based 3D printed anatomy and simulated X-ray imaging using a physical C-arm. To explore the fidelity and usefulness of the proposed mixed-reality system for training and assessment, we conducted a user study with six surgical experts performing a facet joint injection on the simulator.ResultsIn a technical evaluation, we show that our system simulates X-ray images accurately with an RMSE of 1.85mm compared to real X-ray imaging. The participants expressed agreement with the overall realism of the simulation, the usefulness of the system for assessment and strong agreement with the usefulness of such a mixed-reality system for training of novices and experts. In a quantitative analysis, we furthermore evaluated the suitability of the system for the assessment of surgical skills and gather preliminary evidence for validity.ConclusionThe proposed mixed-reality simulation system facilitates a transition to C-arm-based surgery and has the potential to complement or even replace large parts of cadaver training, to provide a safe assessment environment and to reduce the risk for errors when proceeding to patient treatment. We propose an assessment concept and outline the steps necessary to expand the system into a test instrument that provides reliable and justified assessments scores indicative of surgical proficiency with sufficient evidence for validity.