Rush Medical College, Chicago, IL, USA.
Int J Comput Assist Radiol Surg. 2011 Sep;6(5):641-52. doi: 10.1007/s11548-010-0541-5. Epub 2011 Jan 4.
Simulation permits objective assessment of operator performance in a controlled and safe environment. Image-guided procedures often require accurate needle placement, and we designed a system to monitor how ultrasound guidance is used to monitor needle advancement toward a target. The results were correlated with other estimates of operator skill.
The simulator consisted of a tissue phantom, ultrasound unit, and electromagnetic tracking system. Operators were asked to guide a needle toward a visible point target. Performance was video-recorded and synchronized with the electromagnetic tracking data. A series of algorithms based on motor control theory and human information processing were used to convert raw tracking data into different performance indices. Scoring algorithms converted the tracking data into efficiency, quality, task difficulty, and targeting scores that were aggregated to create performance indices. After initial feasibility testing, a standardized assessment was developed. Operators (N = 12) with a broad spectrum of skill and experience were enrolled and tested. Overall scores were based on performance during ten simulated procedures. Prior clinical experience was used to independently estimate operator skill.
When summed, the performance indices correlated well with estimated skill. Operators with minimal or no prior experience scored markedly lower than experienced operators. The overall score tended to increase according to operator's clinical experience. Operator experience was linked to decreased variation in multiple aspects of performance. The aggregated results of multiple trials provided the best correlation between estimated skill and performance. A metric for the operator's ability to maintain the needle aimed at the target discriminated between operators with different levels of experience.
This study used a highly focused task model, standardized assessment, and objective data analysis to assess performance during simulated ultrasound-guided needle placement. The performance indices were closely related to operator experience.
模拟允许在受控和安全的环境中对操作人员的性能进行客观评估。图像引导程序通常需要准确的针放置，我们设计了一种系统来监测超声引导如何用于监测针朝向目标的推进。结果与其他估计操作人员技能的方法相关联。
模拟器由组织体模、超声单元和电磁跟踪系统组成。操作人员被要求将针引导到可见的点目标。性能被视频记录并与电磁跟踪数据同步。基于运动控制理论和人类信息处理的一系列算法用于将原始跟踪数据转换为不同的性能指标。评分算法将跟踪数据转换为效率、质量、任务难度和目标分数，这些分数汇总创建性能指标。经过初步可行性测试后，开发了标准化评估。招募并测试了具有广泛技能和经验的操作人员（N=12）。总体分数基于十个模拟程序期间的性能。先前的临床经验用于独立估计操作人员的技能。
当总和时，性能指标与估计的技能很好地相关。具有最小或没有先前经验的操作人员的得分明显低于经验丰富的操作人员。总体得分往往随着操作人员的临床经验而增加。操作人员的经验与性能的多个方面的变化减少相关。多个试验的综合结果提供了估计技能与性能之间的最佳相关性。用于保持针瞄准目标的操作员能力的度量能够区分具有不同经验水平的操作员。
本研究使用了高度集中的任务模型、标准化评估和客观数据分析来评估模拟超声引导下针放置期间的性能。性能指标与操作人员的经验密切相关。
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