title: Virtual reality simulation objectively differentiates level of carotid stent experience in experienced interventionalists.
abstract: OBJECTIVE
  Technical proficiency in carotid artery stent (CAS) procedures is paramount to ensure patient safety. If virtual reality (VR) simulation is to be used as a valid means for credentialing physicians for CAS procedures, the assessment parameters must be able to evaluate the performance during CAS and to differentiate level of CAS experience. The aim of this study was to validate assessment parameters of a commercially available VR simulator (VIST, Vascular Interventional Surgical Trainer, Mentice, Gothenburg, Sweden) during a CAS procedure in experienced interventionalists.
  
  
  METHODS
  Forty-five interventionalists (cardiologists, radiologists, vascular surgeons) who had performed at least 100 endovascular therapeutic cases, with varying experience in CAS were recruited: groups A, n = 12 (0 CAS procedures), B, n = 12 (1 to 20 CAS), C, n = 10 (21 to 50 CAS) and D, n = 11 (>50 CAS). All subjects performed a standard CAS procedure with a type I arch and were assessed by quantitative (procedure time, amount of contrast given, number of cineloops recorded, fluoroscopic time) and qualitative (clinical parameters and errors) metrics of the simulator. Participants also rated the realism and training potential of the simulator on a scale from 1 (poor) to 5 (excellent).
  
  
  RESULTS
  There were significant differences across the four groups A to D for procedure time (medians 20.5 vs 24 vs 19 vs 16 minutes, P = .002) and fluoroscopic time (12.5 vs 13 vs 10 vs 7 minutes, P < .001), respectively. Total numbers of errors recorded by the VR simulator did not achieve statistical significance (P = .209) across the four groups. All subjects rated the simulator highly (median 4) in terms of realism and training potential.
  
  
  CONCLUSIONS
  Total time and fluoroscopic time both recorded by a realistic VR simulator differentiate between levels of CAS experience in experienced interventionalists. Error scoring is currently not a valid mode of assessment and needs refinement.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, United Kingdom. vhisabelle@gmail.com
authors.forename: Isabelle
authors.initials: I
authors.lastname: Van Herzeele
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Andrew
authors.initials: A
authors.lastname: Choong
authors.forename: Robert
authors.initials: R
authors.lastname: Brightwell
authors.forename: Frank E
authors.initials: FE
authors.lastname: Vermassen
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Cheshire
mesh_terms: D000800:Angioplasty, Balloon / Q000193:education; D002309:Cardiology; D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D015641:Radiography, Interventional; D015607:Stents; D013647:Task Performance and Analysis; D014584:User-Computer Interface