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Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment

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Abstract
This study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario. Virtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists, performed simulated endovascular ruptured aortic aneurysm repair (rEVAR). Timed performance metrics were recorded as surrogate measures of performance. Participants (N = 22) completed postprocedure questionnaires evaluating face validity, as well as technical and human factor aspects, of the simulation on a Likert scale from 1 (not at all) to 5 (very much). Experienced team leaders were significantly faster than trainees in obtaining proximal control with an intra-aortic occlusion balloon (352 vs. 501 s, p = 0.047) and all completed the procedure within the allotted time, whilst no trainee was able to do so. Total fluoroscopy times were significantly lower in the experienced group (782 vs. 1,086 s, p = 0.016). Realism of the simulated angiosuite was scored highly by experienced team leaders (median 4/5, IQR 4-5). Participants found the simulation useful for acquiring technical (4/5, IQR 4-5) and communication skills (4/5, IQR 4-5) and particularly valuable for enhancing teamwork (5/5, IQR 4-5) and patient safety (5/5, IQR 4-5). This study shows feasibility of creation of a crisis scenario in a fully immersive angiosuite simulation and team performance of a simulated rEVAR. Performance metrics differentiated between experienced specialists and trainees, and the realism of the simulation exercise and environment were rated highly by experienced endovascular specialists. This simulation has potential as a powerful training and assessment tool with opportunities to improve team performance in rEVAR through both technical and human factor skills training.
Keywords
Endovascular repair, Ruptured aneurysm, Virtual reality, Simulation, Angiosuite, OPERATING-THEATER, PERFORMANCE, SKILLS, EMERGENCY, ERROR

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Citation

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MLA
Rudarakanchana, Nung, Isabelle Van Herzeele, Colin D Bicknell, et al. “Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: Technical and Team Training in an Immersive Virtual Reality Environment.” CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 37.4 (2014): 920–927. Print.
APA
Rudarakanchana, N., Van Herzeele, I., Bicknell, C. D., Riga, C. V., Rolls, A., Cheshire, N. J., & Hamady, M. S. (2014). Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment. CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 37(4), 920–927.
Chicago author-date
Rudarakanchana, Nung, Isabelle Van Herzeele, Colin D Bicknell, Celia V Riga, Alexander Rolls, Nicholas JW Cheshire, and Mohamad S Hamady. 2014. “Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: Technical and Team Training in an Immersive Virtual Reality Environment.” Cardiovascular and Interventional Radiology 37 (4): 920–927.
Chicago author-date (all authors)
Rudarakanchana, Nung, Isabelle Van Herzeele, Colin D Bicknell, Celia V Riga, Alexander Rolls, Nicholas JW Cheshire, and Mohamad S Hamady. 2014. “Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: Technical and Team Training in an Immersive Virtual Reality Environment.” Cardiovascular and Interventional Radiology 37 (4): 920–927.
Vancouver
1.
Rudarakanchana N, Van Herzeele I, Bicknell CD, Riga CV, Rolls A, Cheshire NJ, et al. Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment. CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY. 2014;37(4):920–7.
IEEE
[1]
N. Rudarakanchana et al., “Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment,” CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, vol. 37, no. 4, pp. 920–927, 2014.
@article{5739685,
  abstract     = {This study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario. 
Virtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists, performed simulated endovascular ruptured aortic aneurysm repair (rEVAR). Timed performance metrics were recorded as surrogate measures of performance. Participants (N = 22) completed postprocedure questionnaires evaluating face validity, as well as technical and human factor aspects, of the simulation on a Likert scale from 1 (not at all) to 5 (very much). 
Experienced team leaders were significantly faster than trainees in obtaining proximal control with an intra-aortic occlusion balloon (352 vs. 501 s, p = 0.047) and all completed the procedure within the allotted time, whilst no trainee was able to do so. Total fluoroscopy times were significantly lower in the experienced group (782 vs. 1,086 s, p = 0.016). Realism of the simulated angiosuite was scored highly by experienced team leaders (median 4/5, IQR 4-5). Participants found the simulation useful for acquiring technical (4/5, IQR 4-5) and communication skills (4/5, IQR 4-5) and particularly valuable for enhancing teamwork (5/5, IQR 4-5) and patient safety (5/5, IQR 4-5). 
This study shows feasibility of creation of a crisis scenario in a fully immersive angiosuite simulation and team performance of a simulated rEVAR. Performance metrics differentiated between experienced specialists and trainees, and the realism of the simulation exercise and environment were rated highly by experienced endovascular specialists. This simulation has potential as a powerful training and assessment tool with opportunities to improve team performance in rEVAR through both technical and human factor skills training.},
  author       = {Rudarakanchana, Nung and Van Herzeele, Isabelle and Bicknell, Colin D and Riga, Celia V and Rolls, Alexander and Cheshire, Nicholas JW and Hamady, Mohamad S},
  issn         = {0174-1551},
  journal      = {CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY},
  keywords     = {Endovascular repair,Ruptured aneurysm,Virtual reality,Simulation,Angiosuite,OPERATING-THEATER,PERFORMANCE,SKILLS,EMERGENCY,ERROR},
  language     = {eng},
  number       = {4},
  pages        = {920--927},
  title        = {Endovascular repair of ruptured abdominal aortic aneurysm: technical and team training in an immersive virtual reality environment},
  url          = {http://dx.doi.org/10.1007/s00270-013-0765-1},
  volume       = {37},
  year         = {2014},
}

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