title: Catheter manipulation analysis for objective performance and technical skills assessment in transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) demands precise and efficient handling of surgical instruments within the confines of the aortic anatomy. Operational performance and dexterous skills are critical for patient safety, and objective methods are assessed with a number of manipulation features, derived from the kinematic analysis of the catheter/guidewire in fluoroscopy video sequences.
  
  
  METHODS
  A silicon phantom model of a type I aortic arch was used for this study. Twelve endovascular surgeons, divided into two experience groups, experts ([Formula: see text]) and novices ([Formula: see text]), performed cannulation of the aorta, representative of valve placement in TAVI. Each participant completed two TAVI experiments, one with conventional catheters and one with the Magellan robotic platform. Video sequences of the fluoroscopic monitor were recorded for procedural processing. A semi-automated tracking software provided the 2D coordinates of the catheter/guidewire tip. In addition, the aorta phantom was segmented in the videos and the shape of the entire catheter was manually annotated in a subset of the available video frames using crowdsourcing. The TAVI procedure was divided into two stages, and various metrics, representative of the catheter's overall navigation as well as its relative movement to the vessel wall, were developed.
  
  
  RESULTS
  Experts consistently exhibited lower values of procedure time and dimensionless jerk, and higher average speed and acceleration than novices. Robotic navigation resulted in increased average distance to the vessel wall in both groups, a surrogate measure of safety and reduced risk of embolisation. Discrimination of experience level and types of equipment was achieved with the generated motion features and established clustering algorithms.
  
  
  CONCLUSIONS
  Evaluation of surgical skills is possible through the analysis of the catheter/guidewire motion pattern. The use of robotic endovascular platforms seems to enable more precise and controlled catheter navigation.
authors.affiliation: Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK. e.mazomenos@ucl.ac.uk.
authors.forename: Evangelos B
authors.initials: EB
authors.lastname: Mazomenos
authors.affiliation: Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK.
authors.forename: Ping-Lin
authors.initials: PL
authors.lastname: Chang
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
authors.forename: Radoslaw A
authors.initials: RA
authors.lastname: Rippel
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rolls
authors.affiliation: Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK.|Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hawkes
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Bicknell
authors.affiliation: Department of Medical Physics and Bioengineering, University College London, London, WC1E 6BT, UK.
authors.forename: Adrien
authors.initials: A
authors.lastname: Desjardins
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
authors.forename: Celia V
authors.initials: CV
authors.lastname: Riga
authors.affiliation: Centre for Medical Image Computing and Department of Computer Science, University College London, London, WC1E 6BT, UK.
authors.forename: Danail
authors.initials: D
authors.lastname: Stoyanov
mesh_terms: D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001696:Biomechanical Phenomena; D006328:Cardiac Catheterization / Q000379:methods*; D002404:Catheterization; D057785:Catheters; D002983:Clinical Competence; D005471:Fluoroscopy; D006801:Humans; D008953:Models, Anatomic; D019047:Phantoms, Imaging; D065287:Robotic Surgical Procedures / Q000379:methods*; D013647:Task Performance and Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Catheter motion analysis; Endovascular robotics; Objective skills assessment