| Popis: |
Endovascular intervention has undergone rapid expansion, largely driven by technological advancement, and has permitted the successful management of complex arterial disease in patients otherwise precluded from operative intervention. Despite refinement and expansion of available endovascular technologies, such techniques can be technically demanding and require considerable expertise. Furthermore, a growing body of evidence suggests that experience and competence have a direct bearing on outcome following such procedures. A number of professional bodies have sought to define competence in terms of number of procedures required to receive specialist certification, however raw procedural figures are regarded by some experts as crude surrogate markers of skill. Endovascular skills are presently assessed using a variety of methods including rating scales, procedure-specific check-lists, computer-generated scoring matrices and metrics derived from fluoroscopic imaging such as contrast volume and procedure time. Although the latter are used in live endovascular intervention to assess novel technologies and techniques, they provide little in the way of qualitative information. Qualitative rating scales have been extensively validated, but are time-consuming and are still largely restricted to experimental work. Video-motion analysis (VMA) is a relatively new concept and prior to this work was unexplored in the field of endovascular surgery. The principle behind this assessment method is the extraction of motion-descriptive data from video recordings. This body of work introduces a novel catheter tracking software capable of extracting this data from fluoroscopic sequences and providing information on the efficiency of endovascular tool movement. Following in-depth examination of the components of endovascular skill on the basis of expert opinion, a comprehensive series of live and simulation-based experiments are presented which demonstrate feasibility and validate this novel software as an assessment method of endovascular technique. Finally, the VMA software is used to evaluate a novel robotic catheter technology, and further ideas for further development of this software are discussed. |
