A Pilot Study of Video-motion Analysis in Endovascular Surgery: Development of Real-time Discriminatory Skill Metrics

ObjectivesAccurate assessment and credentialing of physicians is essential.Objective motion analysis of guide-wire/catheter manipulation to assess proficiency during endovascular interventions remains unexplored. This study aims to assess its feasibility and its role in evaluation of technical ability.Materials and methodsA semi-automated catheter-tracking software was developed which allows for frame-by-frame motion analysis of fluoroscopic videos and calculation 2D catheter tip path-length. 21 interventionalists (6 cardiologists, 8 interventional radiologists, 7 vascular surgeons; 14/21 had performed >500 endovascular procedures) performed an identical carotid artery stenting procedure (CAS) on a VIST simulator (Mentice, Gothenburg, Sweden). Operators were sub-divided into four categories according to CAS experience: 6 inexperienced (0 CAS-group A), 3 low-volume (1–20 CAS-group B), 5 moderate-volume (21–50 CAS-group C) and 7 high-volume (>50 CAS-group D) CAS experience. Total PL was calculated for each case and comparisons made between groups. PL was correlated with: quantitative, simulator-derived metrics and qualitative performance scores (generic and procedure-specific) derived from post-hoc video analysis by three blinded observers.ResultsGroup D used 5160.3 (inter-quartile range- IQR 4046.4–7142.9) pixels of movement, compared to 6856.7 (5914.4–8106.9) for group A (p = 0.046); 10,905.1 (7851.1–14,381.5) for group B (p = 0.017); and 9482.6 (8663.5–13,847.6) for group C (p = 0.003). Statistically significant inverse correlations were seen between total PL and qualitative performance scores (rho = −0.519 for generic (p = 0.027) rho = −0.567 for procedure-specific (p = 0.014) scores). PL did not correlate with any of the simulator-derived metrics (errors, contrast volume, total procedure and fluoroscopy times, cine-loops used).ConclusionEndovascular instrument video motion analysis is feasible and may represent a valuable tool for the objective assessment of endovascular skill.