title: Face and content validation of virtual reality simulation for carotid angiography: results from the first 100 physicians attending the Emory NeuroAnatomy Carotid Training (ENACT) program.
abstract: BACKGROUND
  Increasing time and resource constraints, and the potential for patient complications, has led to an emphasis on finding innovative ways to teach catheter-based procedures outside of the laboratory. Virtual reality (VR) simulator training has been proposed as a potential training solution. We report on the initial validation of a full procedural VR simulator for carotid angiography (CA) using the Vascular Interventional System Trainer (VIST).
  
  
  METHODS
  In all, 100 experienced physicians, currently performing endovascular procedures (71 cardiologists, 29 surgeons, and one radiologist), underwent simulator based training in CA. Each operator completed three VR simulated CAs, and assessed the VIST VR simulator for both its face and content validity.
  
  
  RESULTS
  Assessment involved how the carotid procedure simulation looked and felt as well as how catheters behaved during the completion of the CA. Assessment was rated on a five-point Likert scale. Anatomically, physicians reported that the aortic arch and carotid vasculature were well simulated (mean = 4.4). However, the bony structures and intra-cranial vasculature correlated poorly with actual anatomic structures (means = 2.3 and 1.1, respectively). One-to-one haptic correspondence of catheters during psychomotor movements were felt to be strongly representative of live procedures. The simulated sequence of using guidewires and catheters was rated to be nearly identical to actual CA (means = 4.8).
  
  
  CONCLUSIONS
  VIST represents one of the most sophisticated VR simulators in medicine. Physicians reported that it looked, felt, and behaved similar to working on an actual patient. Future work is required to validate whether this simulator will improve catheter performance on actual patients.
authors.affiliation: Emory Angiographic Simulation Training (EAST) Center, Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Nicholson
authors.forename: Christopher U
authors.initials: CU
authors.lastname: Cates
authors.forename: Amar D
authors.initials: AD
authors.lastname: Patel
authors.forename: Khusrow
authors.initials: K
authors.lastname: Niazi
authors.forename: Spencer
authors.initials: S
authors.lastname: Palmer
authors.forename: Tarek
authors.initials: T
authors.lastname: Helmy
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Gallagher
mesh_terms: D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000503:physiopathology; D002533:Cerebral Angiography / Q000295:instrumentation*; D003198:Computer Simulation; D004502:Education, Medical, Continuing; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D010865:Pilot Projects; D015397:Program Evaluation; D014584:User-Computer Interface