US_cardio_Herzeele.qxp 17/7/08 09:41 Page 41
Interventional Cardiology
Virtual Reality Simulation in the Endovascular Field
a report by
Isabelle Van Herzeele, MD and Rajesh Aggarwal, MD
European Virtual Reality Endovascular Research Team (EVEREST)
The last decade has witnessed exponential growth in the field of endovascular The Procedicus Vascular Intervention Simulation Trainer (VIST™, Mentice,
interventions, although only in the last few years has there been a widespread Gothenburg, Sweden) comprises a mechanical unit housed within a
interest in the carotid artery stent (CAS). Endovascular physicians with different mannequin cover, a high-performance desktop computer, and two display
medical backgrounds such as interventional cardiologists, radiologists, and screens. Modified instruments are inserted through the access port using a
vascular surgeons all recognize the importance of this changing technology.
1
haptic interface device. The term haptic relates to tactile feedback, which is
This procedure is almost unique, as the risks to the patient (stroke and death) created by a series of motorized carts that lock onto the inserted instrument in
as a result of the physician’s learning curve are unacceptably high. This has realtime with force-feedback (i.e. mechanical simulation of the sense of touch).
been summarized by editorials written after the publication of the Carotid and The physician is able to select appropriate endovascular tools and perform
Vertebral Artery Angioplasty Study (CAVATAS)
2–4
and the Endarterectomy interventional procedures using the simulated fluoroscopic screen. The
versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trial performance is measured using assessment parameters such as contrast fluid
(EVA-3S).
5–7
Recent publications of the rates of medical errors and adverse used, total procedure time, fluoroscopy time, clinical parameters (endovascular
events within healthcare
8
have drawn the spotlight toward methods of tools used, stent placement accuracy, etc.), and errors. A procedure report is
establishing credentials for physicians preparing to perform complex provided automatically for each session. Simulation modules include
procedures. In order to improve patient safety, operators must have the atherosclerotic stenotic diseases in coronary and peripheral vessels (carotid,
appropriate cognitive and technical skills and experience of CAS. Furthermore, renal, iliac, superficial femoral artery [SFA]), over-the-wire lead placement for
physicians should have previously achieved a high level of proficiency in other biventricular pacing, closure of patent foramen ovale, neuro-interventions, and
catheter-based interventions and completed dedicated training in CAS.
9,10
insertion and retrieval of a caval filter.
Traditional methods have focused on meeting a minimum number of The Angio Mentor™ family (Simbionix, Ohio, US) has a similar range of
procedures and on the duration of training to ensure competence, simulation modules in the peripheral and coronary arteries and allows
inappropriately correlating experience with competence.
11,12
What is needed, implantation of cardiac pacemaker leads, the management of cardiac rhythm
given the complexity and risk of CAS plus the conflicting skill sets of physicians diseases, and the performance of neuro-interventions. Furthermore, this VR
across several subspecialties, is a standardized and objective method for simulator has incorporated patient monitoring, drug administration, and
assessing procedural performance. Within aviation and in other medical fields response to physiological disturbances during the endovascular procedure and
such as laparoscopy, virtual reality (VR) simulation is able to train and objectively the occurrence of complications. Two cheaper and more portable editions are
assess technical performance, and subsequently to define the benchmark level
of skill.
13–15
Therefore, the three specialties involved in the treatment of CAS
have joined forces and launched the European Virtual Reality Endovascular
European Virtual Reality Endovascular
Research Team (EVEREST). The ultimate goal of this group is to improve the
Research Team (EVEREST)
training of current and future endovascular therapists.
Rajesh Aggarwal, MD, Clinical Lecturer, Imperial College Healthcare
In this article, an overview of different endovascular VR simulators and
Trust, London
Nick Cheshire, MD, Professor of Vascular Surgery, Imperial College
validation studies will be given, highlighting the role of the EVEREST members.
Healthcare Trust, London
Additionally, the possible benefits of VR simulation in the endovascular field,
Peter Gaines, MD, Professor of Interventional Radiology, Sheffield
integration of VR simulation within a proficiency-based endovascular
Vascular Institute, Northern General Hospital, Sheffield
curriculum, and future applications will be explained.
Mohamad Hamady, MD, Consultant Interventional Radiologist,
Imperial College Healthcare Trust, London
Virtual Reality Simulator Overview Isabelle Van Herzeele, MD, Senior Research and Clinical Vascular
Dawson defines a simulator as a physical object that reproduces, to a Fellow, Ghent University Hospital, Ghent
greater or lesser degree of realism, a procedure that must be learned and
Iqbal Malik, MD, Consultant Interventional Cardiologist, Imperial
which incorporates a system of metrics that allows progress and learning to
College Healthcare Trust, London
be recorded.
16
In 2000, his article describing the first advanced vascular
Frank Vermassen, MD, Professor of Thoracic and Vascular Surgery,
simulator was published.
17
Now, there are at least four commercially
Ghent University Hospital, Ghent
endovascular simulators available.
© TOUCH BRIEFINGS 2008
41
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84