Virtual reality, ultrasound-guided liver biopsy simulator: Development and performance discrimination

Johnson, SJ; Hunt, CM; Woolnough, HM; Crawshaw, M; Kilkenny, C; Gould, DA; England, A; Sinha, A; Villard, PF

Abstract

Objectives: The aim of this article was to identify and prospectively investigate simulated ultrasound-guided targeted liver biopsy performance metrics as differentiators between levels of expertise in interventional radiology.
Methods: Task analysis produced detailed procedural step documentation allowing identification of critical procedure steps and performance metrics for use in a virtual reality ultrasound-guided targeted liver biopsy procedure. Consultant (n=14; male=11, female=3) and trainee (n=26; male=19, female=7) scores on the performance metrics
were compared. Ethical approval was granted by the Liverpool Research Ethics Committee (UK). Independent t-tests and analysis of variance (ANOVA) investigated differences between groups.
Results: Independent t-tests revealed significant differences between trainees and consultants on three performance metrics: targeting, p=0.018, t=22.487 (22.040 to
20.207); probe usage time, p=0.040, t=2.132 (11.064 to 427.983); mean needle length in beam, p=0.029, t=22.272 (20.028 to 20.002). ANOVA reported significant differences across years of experience (0–1, 1–2, 3+ years) on seven performance metrics: no-go area touched, p=0.012; targeting, p=0.025; length of session, p=0.024; probe usage time, p=0.025; total needle distance moved, p=0.038; number of skin contacts, p<0.001; total time in no-go area, p=0.008. More experienced participants consistently received better performance scores on all 19 performance metrics.
Conclusion: It is possible to measure and monitor performance using simulation, with performance metrics providing feedback on skill level and differentiating levels of expertise. However, a transfer of training study is required.

• Journal Article Type: Article
• Deposit Date: Sep 6, 2013
• Publicly Available Date: Sep 6, 2013
• Journal: British Journal of Radiology
• Print ISSN: 0007-1285
• Electronic ISSN: 1748-880X
• Publisher: British Institute of Radiology
• Peer Reviewed: Peer Reviewed
• Volume: 85
• Pages: 555-561
• DOI: https://doi.org/10.1259/bjr/47436030
• Publisher URL: http://dx.doi.org/10.1259/bjr/47436030
• Related Public URLs: http://www.bir.org.uk/publications/journals/