Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa, USA.
Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA.
J Orthop Res. 2024 Feb;42(2):404-414. doi: 10.1002/jor.25685. Epub 2023 Sep 24.
Psychomotor skill and decision-making efficiency in surgical wire navigation can be objectively evaluated by analysis of intraoperative fluoroscopic image sequences. Prior work suggests that such image-based behavior analysis of operating room (OR) performance can predict performer experience level (R = 0.62) and agree with expert opinion (the current standard) on the quality of a final implant construct (R = 0.59). However, it is unclear how objective image-based evaluation compares with expert assessments for entire technical OR performances. This study examines the relationships between three key variables: (1) objective image-based criteria, (2) expert opinions, and (3) performing surgeon experience level. A paired-comparison survey of seven experts, based upon eight OR fluoroscopic wire navigation image sequences, shows that the experts' preferences are best explained by objective metrics that reflect psychomotor and decision-making behaviors which are counter-productive to successful implant placement, like image count (R = 0.83) and behavior tally (R = 0.74). One such behavior, adjustments away from goal, uniquely correlated well with all three key variables: a fluoroscopic image-based analysis composite score (R = 0.40), expert consensus (R = 0.76), and performer experience (R = 0.41). These results confirm that experts view less efficient technical behavior as indicative of lesser technical proficiency. While expert assessments of technical skill were reliable and consistent, neither individual nor consensus expert opinion appears to correlate with performer experience (R = 0.11).
手术中导丝导航的运动技能和决策效率可以通过分析术中荧光透视图像序列来客观评估。先前的工作表明，这种基于图像的手术室（OR）绩效行为分析可以预测执行者的经验水平（R=0.62），并与专家意见（当前标准）在最终植入物结构的质量上达成一致（R=0.59）。然而，目前尚不清楚基于客观图像的评估与专家对整个技术 OR 绩效的评估相比如何。本研究检验了三个关键变量之间的关系：（1）客观的基于图像的标准，（2）专家意见，和（3）执行外科医生的经验水平。对七位专家进行了基于八项 OR 荧光透视导丝导航图像序列的配对比较调查，结果表明，专家的偏好可以通过反映不利于成功植入的运动技能和决策行为的客观指标来最好地解释，例如图像计数（R=0.83）和行为计数（R=0.74）。其中一种行为，即偏离目标的调整，与所有三个关键变量都很好地相关：一个基于荧光透视图像的分析综合评分（R=0.40）、专家共识（R=0.76）和执行者的经验（R=0.41）。这些结果证实，专家认为效率较低的技术行为表明技术熟练程度较低。虽然专家对技术技能的评估是可靠且一致的，但个人和共识专家意见似乎都与执行者的经验无关（R=0.11）。
