Vascular Intervention Simulation Research Articles

Knowledge atlas analysis of virtual vascular interventional studies

To examine the research status, hot spots, and development trend of virtual vascular intervention simulation training in order to organize the knowledge and support its practice. Publications on virtual vascular intervention and respective teaching evaluation (2001-2021) were retrieved from Web of Science. Citespace 5.2.R2 and Carrot2 software was used to perform the bibliometric and visual analysis on virtual vascular intervention research networks. Of the 1543 articles retrieved, 1520 were relevant to virtual vascular intervention research. Studies on vascular intervention emerged from 2002 with an upward trend being observed from 2010. The trend peaked between 2019 and 2020 with ∼140 published articles (9.21%) during the period. Spain published most studies (n = 146) followed by USA (n = 99) and England (n = 49). COMPUT EDUC (n = 177; 14.47%) journal publishing the highest number of articles. Among 705 authors, GARRISON D R, MAYER RE, DEDE C, COOK DA had highest publications. The frequent keywords used were "Virtual reality" (n = 105) and "education" (n = 105). Low cooperation between countries, authors' networks, and relatively stable academic team was noted making clinical application of virtual vascular intervention weak. Considerable growth was observed in vascular intervention therapy using VR technology in the last 20 years. With consistent efforts like strengthening cross-institutional and multidisciplinary collaboration networks, VR based simulation training capability can be increased that in turn can improve the outcomes of complex vascular interventions.

Mechanical Properties of a 3 Dimensional–Printed Transparent Flexible Resin Used for Vascular Model Simulation Compared with Those of Porcine Arteries

PurposeTo develop a vascular intervention simulation model that replicates the characteristics of a human patient and to compare the mechanical properties of a 3-dimensional (3D)–printed transparent flexible resin with those of porcine arteries using the elastic modulus (E) and kinetic friction coefficient (μk). Materials and MethodsResin plates were created from a transparent flexible resin using a 3D printer. Porcine artery plates were prepared by excising the aorta. E values and the adhesive strengths of the resin and arterial surfaces toward a polyethylene plate, were measured with a tensile-compressive mechanical tester. Resin transparency was measured using an ultraviolet-visible light spectrometer. The μk value of the resin plate surface after applying silicone spray for 1–5 seconds and that of the artery were measured using a translational friction tester. ResultsE values differed significantly between the arteries and resin plates at each curing time (0.20 MPa ± 0.04 vs 8.53 MPa ± 2.37 for a curing time of 1 minute; P < .05). The resin was stiffer than the arteries, regardless of the curing times. The visible light transmittance and adhesive strength of the resin decreased as the curing time increased. The adhesive strength of the artery was the lowest. The μk value of the silicone-coated resin surface created by applying silicone for 2–3 seconds (thickness of the silicone layer, 1.6–2.0 μm) was comparable with that of the artery, indicating that the coating imparted a similar slippage to the resin as to the living artery. ConclusionsA transparent flexible resin is useful for creating a transparent and slippery vascular model for vascular intervention simulation.

Personalized cardiovascular intervention simulation system

BackgroundThis study proposes a series of geometry and physics modeling methods for personalized cardiovascular intervention procedures, which can be applied to a virtual endovascular simulator. MethodsBased on personalized clinical computed tomography angiography (CTA) data, mesh models of the cardiovascular system were constructed semi-automatically. By coupling 4D magnetic resonance imaging (MRI) sequences corresponding to a complete cardiac cycle with related physics models, a hybrid kinetic model of the cardiovascular system was built to drive kinematics and dynamics simulation. On that basis, the surgical procedures related to intervention instruments were simulated using specially-designed physics models. These models can be solved in real-time; therefore, the complex interactions between blood vessels and instruments can be well simulated. Additionally, X-ray imaging simulation algorithms and realistic rendering algorithms for virtual intervention scenes are also proposed. In particular, instrument tracking hardware with haptic feedback was developed to serve as the interaction interface of real instruments and the virtual intervention system. Finally, a personalized cardiovascular intervention simulation system was developed by integrating the techniques mentioned above. ResultsThis system supported instant modeling and simulation of personalized clinical data and significantly improved the visual and haptic immersions of vascular intervention simulation. ConclusionsIt can be used in teaching basic cardiology and effectively satisfying the demands of intervention training, personalized intervention planning, and rehearsing.

A robust and real-time vascular intervention simulation based on Kirchhoff elastic rod

A virtual reality (VR) based vascular intervention simulation system is introduced in this paper, which helps trainees develop surgical skills and experience complications in safety remote from patients. The system simulates interventional radiology procedures, in which flexible tipped guidewires are employed to advance diagnostic or therapeutic catheters into vascular anatomy of a patient. A real-time physically-based modeling approach ground on Kirchhoff elastic rod is proposed to simulate complicated behaviors of guidewires and catheters. The slender body of guidewire and catheter is modeled using more efficient special case of naturally straight, isotropic Kirchhoff rods, and the shorter flexible tip composed of straight or angled design is modeled using more complex generalized Kirchhoff rods. The motion equations for guidewire and catheter were derived with continuous elastic energy, followed by a discretization using a linear implicit scheme that guarantees stability and robustness. In addition, we used a fast-projection method to enforce the inextensibility of guidewire and catheter. An adaptive sampling algorithm was also implemented to improve the simulation efficiency without decrease of accuracy. Experimental results revealed that our system is both robust and efficient in a real-time performance.

Technical Skills Assessment in a Coronary Angiography Simulator for Construct Validation

The aim of this study was to evaluate technical skills in a coronary angiography (CA) simulator to establish the performance level of trainees and experts in virtual CA.The traditional master-apprentice way of learning CA is by practicing on patients despite a known risk for complications during training. Safe CA training is warranted, and simulators might be one possibility. Simulators used must be validated regarding their ability to separate trainees from experts. Construct validation of a CA simulator, to our knowledge, has not yet been published. Ten cardiology residents without experience in CA, 4 intermediate, and 10 CA experts performed 5 CAs in the Mentice VIST (Vascular Intervention Simulation Trainer). Metrics reflecting proficiency skills such as total procedure time, fluoroscopy time, and contrast volume were extracted from the simulator computer and compared between the groups. All examinations were videotaped, and the number of handling errors was examined. The videos were evaluated by 2 experts blinded to the test object's performance level. Experts outperformed trainees in all metrics measured by the simulator. Improvement was demonstrated in all metrics through all 5 CAs. Furthermore, beginners had more handling errors compared with experts. Mentice VIST simulator can distinguish between trainees and experts in CA in the metrics extracted from the computer and therefore prove the concept of construct validity.

Skills Transfer After Proficiency-Based Simulation Training in Superficial Femoral Artery Angioplasty

The purpose of this study was to explore whether basic endovascular skills acquired using proficiency-based simulation training in superficial femoral artery (SFA) angioplasty translate to real-world performance. Five international experts were invited to evaluate a preliminary 28-item rating scale for SFA angioplasty using a modified Delphi study. To test the procedural scale, 4 experts and 11 final-year medical students then performed 2 SFA angioplasties each on the vascular intervention simulation trainer simulator. Thereafter, 10 general surgical residents (novices) received didactic training in SFA angioplasty. Trainees were then randomized with 5 trainees receiving further training on the vascular intervention simulation trainer simulator up to proficiency level. All 10 trainees then performed 1 SFA angioplasty on a patient within 5 days of training. The trainees' performance was assessed by 1 attending consultant blinded to the trainees' training status, using the developed procedural scale and a global rating scale. Four items were eliminated from the procedural scale after the Delphi study. There were significant differences in the procedural scale scores between the experts and the students in the first trial [mean (SD), 94.25 (2.22) vs. 74.90 (8.79), P = 0.001] and the second trial [95.25 (0.50) vs. 76.82 (9.44), P < 0.001]. Simulation-trained trainees scored higher than the controls on the procedural scale [86.8 (5.4) vs. 67.6 (6), P = 0.001] and the global rating scale [37.2 (4.1) vs. 24.4 (5.3), P = 0.003]. Basic endovascular skills acquired using proficiency-based simulation training in SFA angioplasty do translate to real-world performance.

Impact of an Assistant on the Technical Skills of the Primary Operator in Superficial Femoral Artery Angioplasty

To assess the impact of an assistant on the technical skills of the operator performing superficial femoral artery (SFA) angioplasty on the vascular intervention simulation trainer (VIST) simulator. Eight experts performed 2 SFA angioplasties each on the VIST. Four experts had an assistant available. Experts' video recordings were blindly evaluated using global and procedural rating scales. Experts with assistants scored higher than the controls in the first: global rating scale (47.8 ± 0.5 vs 33.5 ± 5.1, P = .01); procedural rating scale (94.3 ± 2.2 vs 89 ± 2.5, P = .02) and the second procedure: global rating scale (47.8 ± 0.5 vs 38 ± 7, P = .03); procedural rating scale (95.3 ± 0.5 vs 89.5 ± 2.4, P = .02). The presence of an assistant had a positive influence on the technical skills of the operator performing SFA angioplasty on the VIST simulator.

脳動脈瘤コイル塞栓術におけるコンピューターシミュレーター（VIST）を用いた技能分析

脳動脈瘤コイル塞栓術におけるコンピューターシミュレーター（VIST）を用いた技能分析

Cognitive training improves clinically relevant outcomes during simulated endovascular procedures

Virtual reality (VR) simulation has been suggested to objectively assess endovascular skills. The aim of this study was to determine the impact of cognitive training on technical performance of inexperienced subjects on a commercially available VR simulator (VIST, Vascular Intervention Simulation Trainer, Mentice, Gothenburg, Sweden). Forty-seven subjects treated an identical virtual iliac artery stenosis endovascularly. Surgical trainees without endovascular experience were allocated to two training protocols: group A(1) (n = 10) received a 45 minute didactic session followed by an expert demonstration of the procedure that included error-based learning, whereas group A(2) (n = 10) was only given a demonstration of an iliac dilation and stent procedure. All trainees performed the intervention immediately following the expert demonstration. Twenty-seven endovascular physicians were recruited (>100 endovascular interventions). Performance was assessed using the quantitative (procedure and fluoroscopy time) and qualitative (stent/vessel ratio and residual stenosis) assessment parameters recorded by the simulator. The end-product (qualitative metrics) in the cognitive-skills group A(1) was similar to those of the endovascular physicians, though A(2) performed significantly worse than the physicians (group B): stent/vessel ratio (A(1) 0.89 vs B 0.96, P = .960; A(2) 0.66 vs B 0.96, P = .001) and residual stenosis (A(1) 11 vs B 4%, P = .511; A(2) 35 vs B 4%, P < .001). Group A(1) took longer to perform the procedure (A(1) 982 vs B 441 seconds, P < .001), with greater use of fluoroscopy than group B (A(1) 609 vs B 189 seconds, P < .001) whereas group A(2) performed the intervention as quickly as group B (A(2) 358 vs B 441 seconds, P = .192) but used less fluoroscopy (A(2) 120 vs 189 seconds, P = .002). Cognitive-skills training significantly improves the quality of end-product on a VR endovascular simulator, and is fundamental prior to assessment of inexperienced subjects.

Analysis of Simulated Angiographic Procedures: Part 1—Capture and Presentation of Audio and Video Recordings

To assess different methods of recording angiographic simulations and to determine how such recordings might be used for training and research. Two commercially available high-fidelity angiography simulations, the Mentice Vascular Interventional Simulation Trainer and the Simbionix AngioMentor, were used for data collection. Video and audio records of simulated procedures were created by different methods, including software-based screen capture, video splitters and converters, and external cameras. Recording parameters were varied, and the recordings were transferred to computer workstations for postprocessing and presentation. The information displayed on the simulators' computer screens could be captured by each method. Although screen-capture software provided the highest resolution, workflow considerations favored a hardware-based solution that duplicated the video signal and recorded the data stream(s) at lower resolutions. Additional video and audio recording devices were used to monitor the angiographer's actions during the simulated procedures. The multiple audio and video files were synchronized and composited with personal computers equipped with commercially available video editing software. Depending on the needs of the intended audience, the resulting files could be distributed and displayed at full or reduced resolutions. The capture, editing, presentation, and distribution of synchronized multichannel audio and video recordings holds great promise for angiography training and simulation research. To achieve this potential, technical challenges will need to be met, and content will need to be tailored to suit the needs of trainees and researchers.

Robustness and complexity of a minimally invasive vascular intervention simulation system

Minimally invasive vascular interventions offer advantages over open surgery. Thorough training is needed to master the skills required to correctly perform these minimally invasive interventions. Simulation is becoming a potential alternative for training. We have developed the foundation, i.e., the algorithmics and models, for a minimally invasive vascular intervention simulation system focusing on guide-wire manipulations. In this article we address the robustness, accuracy, and complexity of this foundation using a phantom. To this end the theory on which the simulation is based is used to formulate constraints on the simulation parameters. Furthermore, the parameter space has been explored in order to optimize the trade-off we are facing: accuracy versus speed of the simulation. A physical experiment setup has been designed that allows us to obtain ground-truth data. The accuracy of the simulation has been determined by comparing physical experimental results with various simulations. For multiple combinations of parameter settings the simulation supplies a guide-wire configuration with a root-mean-square error around 1 mm. The results show that the speed of the simulation is still an issue and needs to be improved. Nevertheless, the results also indicate that the developed algorithms and models are a robust foundation to build a simulation system on.