Exploration of Interventionists’ Technical Manipulation Skills for Robot-Assisted Intravascular PCI Catheterization

Wenjing Du,Yousef Al-Handarish,Wenke Duan,Shipeng Han,Yifa Li,Olatunji Mumini Omisore,Qiuhua Liu,Xiaodan Lv,Tao Zhou,Lei Wang

doi:10.1109/access.2020.2980579

Abstract

Despite the great proven advantages of imaging techniques in percutaneous coronary interventions (PCIs), the recent rapid increase in the number of PCI procedures exposes both surgical experts and patients to more radiation and orthopedic hazards in the intervention room. While patients are minimally exposed, many appearance of interventionists subject them to frequent exposure of the operational hazards. Despite promoting the use of robot-assisted intravascular PCI in the Cath-Labs, cognitive and technical skills of interventionists’ are yet to be explored towards reducing procedure time and minimal exposure of surgeon to operational hazards. In this study, a random forest classification framework is developed for proper identification of technical manipulation skills of surgeons along with underlying motion patterns of the flexible intravascular tools ( viz. guidewire and catheter) during PCI catheterization. For this purpose, analysis of interventionists’ muscular activities and related hand motion were decoded from physiological signals recorded with sensors. Surface electromyography, electromagnetic, and tactile force signals were acquired concurrently from seven interventionists during specified guidewire movement viz. pull, push, rotate-pull (clockwise rotation with pull), rotate-push (counterclockwise rotation with push) , CR (clockwise rotation), and CCR (counterclockwise rotation). While relations were established between force and muscle activities in the surgeon groups using Spearman’s Rank-Order statistical method, Wilcoxon test and Kruskal-Wallis one-way ANOVA test were employed to identify intra-group and inter-group differences. From the experimental results obtained, guidewire delivery patterns exhibit stable characteristics with overall classification accuracies of 94.11% based on nineteen features subset from muscle activities and hand motion, followed by 88.01% based on twelve features subset from muscle activities, 71.97% based on seven features subset from hand motion, 84.56% based on ten features subset from part muscle activities and hand motion. Thus, this study shows existence of significant correlation (p < 0.05) between force and muscle activity during intravascular catheterization for PCIs, while comparably high tactile force values were experience in vascular model with plaque or stenosis.

Highlights

IMPLEMENT AND VERIFICATION OF RELEVANT BEHAVIOR SELECTION BASED ON THE CLASSIFICATION FRAMEWORK In this study, the interventionists’ manipulation skills are analyzed based on the muscle activities (MA) extracted from surface electromyography (sEMG) signals, and the hand motion (HM) signals based on EM sensors and flexible pressure sensor (PF)
The nineteen features including MAAPB, MAFCR, MADI, MAECR, from sEMG of the muscle activities; PF, HMDFx, HMDFy, HMDFz, HMDTx, HMDTy, HMDTz from the hand motion data were all extracted as descibed in Section II, and used as input parameters of the classification framework
WORK This pilot study was carried out to verify if sEMG signals of muscle activity based on sEMG sensors, EM data and force of hand motion can be used to explore surgeons’ manipulation skills for integration into robotic percutaneous coronary interventions (PCIs) procedures

Summary

Introduction

Cardiovascular diseases is a group of non-communicable heart-related diseases characterized with high morbidity and. W. Du et al.: Exploration of Interventionists’ Technical Manipulation Skills for Robot-Assisted Intravascular PCI Catheterization mortality which remains the annual leading cause of death, worldwide [1]. Despite characterizing cardiovascular diseases with casual symptoms which include chest pain, dyspnea, palpitations and fainting of victims have enhanced timely suspicion on onset, proper diagnosis and therapy requires angiographic and angioplastic procedures both involving percutaneous coronary intervention (PCI) [2]–[5]. During the typical minimally invasive procedures, flexible endovascular tools including catheters and guidewires are steered through single peripheral port dissected around the femoral or radial vessels for intravascular passage into the cardiac cavity for checking existence of vasoconstriction or vasodilation, or rebuilding blood flow pathways in coronary arteries. PCI technique is embroiled with several challenges wherein exposure of interventionists to radiation and orthopedic spine injuries is of great concern

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