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Medical Practice
Figure 2: Comparisons Between Simulated
the appropriate devices before the actual procedure, resulting in shorter
Angiograms and Real Angiograms
procedure time, less unnecessary equipment, and, ultimately, higher
success rates and fewer complications.”
11
AB
In October 2008, Hislop et al. of the University of Rochester Medical
Center presented the results of a face validation study of the PROcedure
Rehearsal Studio to the New England Society for Vascular Surgery
(NESVS). Their objectives were, “To determine whether a patient’s
specific carotid anatomy can be modeled using CTA on an endovascular
simulator and whether pre-operative patient-specific case rehearsal
accurately predicts operative experience.”
12
In their report, the
researchers concluded that “…the surgeons strongly agreed (median
score 5/5) that the simulation improved the operative flow, increased
patient safety and efficiency of instrument use, assisted in the selection
CD of EPD, stent, diagnostic catheter and balloon, decreased overall
operative and fluoroscopy time and the amount of contrast used, and
that the operative and simulator outcomes were similar. They agreed
(median score 4/5) that the simulation assisted with vessel access and
with wire selection. Face validity was excellent, and surgeons strongly
agreed that the simulator was easy to use, realistically replicated reality,
produced realistic imaging and tactile feedback (haptics), realistically
replicated patient arch, carotid, and lesion anatomy, and accurately
predicted stent dimensions. All simulated EPD, stent, and balloon
dimensions matched those used in the operating room. Subjective
observations suggested that the simulation predicted difficulty with
A: Simulated arch; B: Operative arch; C: Simulated angiogram; D: Operative angiogram.
vessel cannulation but did not accurately model post-stent deployment
changes in bifurcation angulation.”
12
The researchers concluded that,
proprietary modeling software. This ability to rapidly create a simulated “These data indicate that patient-specific computed tomography
case from actual patient data not only supports procedure rehearsal for angiogram (CTA)-derived data can be converted to an endovascular
that particular case, but also has the potential to create an unlimited
library of simulated carotid stenting cases for training and analysis. This
effectively indefinitely extends the utility of the Simbionix ANGIO Mentor A revolutionary aspect of the Simbionix
as a training device.
PROcedure Rehearsal Studio is that the
Comments, Studies, and Expereiences process of importing a patient’s computed
Regarding Simbionix ANGIO Mentor and
PROcedure Rehearsal Studio
tomography data into the simulation can
A number of researchers have conducted studies on the opinions or be easily accomplished using Simbionix’s
experiences of interventional cardiologists, interventional radiologists, and
proprietary modeling software.
vascular surgeons regarding their use of the Simbionx ANGIO Mentor
and PROcedure Rehearsal Studio. A few of these are summarized below.
simulator with high face validity. We suggest that case rehearsal prior to
During a live broadcast at the Transcatheter Cardiovascular Therapetuics an operation may be useful in the planning and execution of carotid
(TCT) 2006 Annual Conference in Washington, Dr Bill Gray of Columbia artery intervention.”
12
Figure 2 shows images used by Hislop et al. to
University and his catheter laboratory team successfully performed a demonstrate the similarity between the simulated and real angiograms.
carotid intervention. What made this live broadcast unique was that one
day earlier Dr Gray had practiced the procedure on a Simbionx ANGIO Ongoing and Planned Studies Regarding
Mentor and PROcedure Rehearsal Studio using a simulated model of the PROcedure Rehearsal Studio
patient’s anatomy. During the live broadcast, the team said they believed The Department of Biosurgery and Surgical Technology at Imperial College
that as a result of the patient-based training they used less contrast and London is conducting research in the field of procedure-specific
less X-ray time and, most importantly, were able to improve patient endovascular virtual reality simulation. The research focuses on examining
safety.
11
During the discussion after the procedure, Dr Giora Weisz, an whether patient-specific rehearsal of a carotid artery stent (CAS)
interventional cardiologist from the Cardiovascular Research Foundation procedure has an influence on the attitudes of physicians toward
(CRF) and Columbia University Medical Center, stated, “I believe endovascular tool selection and the use of fluoroscopy. Results of this
patient-based simulation can significantly improve patient safety by study will be presented at the June 2009 Annual Meeting of the Society for
training physicians on the patient’s own anatomy and by practicing with Vascular Surgery (SVS) in Denver. Further research will involve examining
94 US CARDIOLOGY
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