title: Comparative ergonomic workflow and user experience analysis of MRI versus fluoroscopy-guided vascular interventions: an iliac angioplasty exemplar case study.
abstract: OBJECTIVE
  A methodological framework is introduced to assess and compare a conventional fluoroscopy protocol for peripheral angioplasty with a new magnetic resonant imaging (MRI)-guided protocol. Different scenarios were considered during interventions on a perfused arterial phantom with regard to time-based and cognitive task analysis, user experience and ergonomics.
  
  
  METHODS
  Three clinicians with different expertise performed a total of 43 simulated common iliac angioplasties (9 fluoroscopic, 34 MRI-guided) in two blocks of sessions. Six different configurations for MRI guidance were tested in the first block. Four of them were evaluated in the second block and compared to the fluoroscopy protocol. Relevant stages' durations were collected, and interventions were audio-visually recorded from different perspectives. A cued retrospective protocol analysis (CRPA) was undertaken, including personal interviews. In addition, ergonomic constraints in the MRI suite were evaluated.
  
  
  RESULTS
  Significant differences were found when comparing the performance between MRI configurations versus fluoroscopy. Two configurations [with times of 8.56 (0.64) and 9.48 (1.13) min] led to reduce procedure time for MRI guidance, comparable to fluoroscopy [8.49 (0.75) min]. The CRPA pointed out the main influential factors for clinical procedure performance. The ergonomic analysis quantified musculoskeletal risks for interventional radiologists when utilising MRI. Several alternatives were suggested to prevent potential low-back injuries.
  
  
  CONCLUSIONS
  This work presents a step towards the implementation of efficient operational protocols for MRI-guided procedures based on an integral and multidisciplinary framework, applicable to the assessment of current vascular protocols. The use of first-user perspective raises the possibility of establishing new forms of clinical training and education.
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK. fabiola.fg@gmail.com.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Fernández-Gutiérrez
authors.affiliation: Centre for Psychology, Abertay University, Dundee, UK.|eHealth and Healthcare Centre, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
authors.forename: Santiago
authors.initials: S
authors.lastname: Martínez
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Rube
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Cox
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Fatahi
authors.affiliation: Centre for Psychology, Abertay University, Dundee, UK.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Scott-Brown
authors.affiliation: Department of Clinical Radiology, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.|Medical Research Institute, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
authors.forename: J Graeme
authors.initials: JG
authors.lastname: Houston
authors.affiliation: Medical Research Institute, The Institute of Cardiovascular Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: McLeod
authors.affiliation: Department of Clinical Radiology, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.|Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: White
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: French
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Mariana
authors.initials: M
authors.lastname: Gueorguieva
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Erwin
authors.initials: E
authors.lastname: Immel
authors.affiliation: Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 21FD, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Melzer
mesh_terms: D017130:Angioplasty / Q000379:methods*; D003198:Computer Simulation; D006804:Ergonomics; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D017543:Iliac Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D057188:Workflow
keywords: Ergonomic analysis; Interventional MRI workflow; MR-guided angioplasty; Retrospective protocol analysis