title: Identifying the Learning Curve for Uterine Artery Embolisation in an Interventional Radiological Training Unit.
abstract: OBJECTIVE
  A clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.
  
  
  METHODS
  Ten IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to three groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).
  
  
  RESULTS
  Mean fluoroscopy time was 18.4 (± 8.1), 17.3 (± 9.0), 16.3 (± 8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4%.
  
  
  CONCLUSIONS
  UAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.
authors.affiliation: Department of Radiology, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK, rajdas@nhs.net.
authors.forename: Raj
authors.initials: R
authors.lastname: Das
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.forename: Haofan
authors.initials: H
authors.lastname: Wang
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Belli
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D005257:Fellowships and Scholarships; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D059032:Learning Curve; D011829:Radiation Dosage; D015642:Radiology, Interventional / Q000193:education*; D012189:Retrospective Studies; D013337:Students, Medical; D013997:Time Factors; D006113:United Kingdom; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data*