Objective assessment of colonoscope manipulation skills in colonoscopy training

Holden, Matthew S.; Wang, Chang Nancy; MacNeil, Kyle; Church, Ben; Hookey, Lawrence; Fichtinger, Gabor; Ungi, Tamás

doi:10.1007/s11548-017-1676-4

Cited by 4 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, we provide evidence that our training paradigm can improve this common weakness of novices. Our findings that Perk Tutor can objectively measure colonoscopy performance metrics aligns with the results of Holden et al 17 .…”

Section: Resultssupporting

confidence: 91%

“…In a study focusing specifically on repetitive strain injury of the right wrist as a result of performing the procedure, Mohankumar et al used a magnetic tracking system with a glove on the operator's right hand 15 . Svendson et al used an optical flow-based algorithm with a Microsoft Kinect™ to score colonoscopies 16 , and Holden et al used electromagnetic tracking of the wrists and elbows to compare novices and experts by their ranges of motion 17 . Nerup et al used magnetic endoscope imaging to track the scope tip paths of novices and experts 18 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analyzing colonoscopy training learning curves using comparative hand tracking assessment

Barr

Hookey

Ungi

et al. 2023

Medical Imaging 2023: Image-Guided Procedures, Robotic Interventions, and Modeling

Self Cite

View full text Add to dashboard Cite

A competency-based approach for colonoscopy training is particularly important, since the amount of practice required for proficiency varies widely between trainees. Though numerous objective proficiency assessment frameworks have been validated in the literature, these frameworks rely on expert observers. This process is time-consuming, and as a result, there has been increased interest in automated proficiency rating of colonoscopies. This work aims to investigate sixteen automatically computed performance metrics, and whether they can measure improvements in novices following a series of practice attempts. This involves calculating motion-tracking parameters for three groups: untrained novices, those same novices after undergoing training exercises, and experts. Both groups had electromagnetic tracking markers fixed to their hands and the scope tip. Each participant performed eight testing sequences designed by an experienced clinician. Novices were then trained on 30 phantoms and re-tested. The tracking data of these groups were analyzed using sixteen metrics computed by the Perk Tutor extension for Slicer. Statistical differences were calculated using a series of three t-tests, adjusting for multiple comparisons. All sixteen metrics were statistically different between pre-trained novices and experts, which provides evidence of their validity as measures of performance. Experts had fewer translational or rotational movements, a shorter and more efficient path, and performed the procedure faster. Pre-and post-trained novices did not significantly differ in average velocity, motion smoothness, or path inefficiency.

show abstract

Section: Resultssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Analyzing colonoscopy training learning curves using comparative hand tracking assessment

Barr

Hookey

Ungi

et al. 2023

Medical Imaging 2023: Image-Guided Procedures, Robotic Interventions, and Modeling

Self Cite

View full text Add to dashboard Cite

show abstract

“…Experts made fewer movements compared to novices and completed the study objectives in less time. In other studies, economy of motion has been well-validated as an assessment tool for procedural expertise, including colonoscopy [25,[27][28][29][30]. For the colonoscope handle controller, most of the difference in hand motion between experts and novices is attributable to the left hand (Table 2).…”

Section: Discussionmentioning

confidence: 98%

“…The primary outcomes compared were time to task completion, total distance traveled, and the number of discrete movements, as assessed by HMA. These are previously validated metrics for expertise in procedural tasks, including endoscopy [25,[27][28][29][30]. The number of keystrokes was also assessed as we hypothesized that less experienced operators may press buttons unnecessarily.…”

Section: Study Proceduresmentioning

confidence: 99%

Design and Validity Evidence for a Unique Endoscopy Simulator Using a Commercial Video Game

Vergis¹,

Unger²,

Park³

et al. 2021

Cureus

View full text Add to dashboard Cite

BackgroundProcedural simulation enhances early endoscopy training. Multiple commercial simulators are available; however, their application is limited by cost and poor user compliance. First-person "shooter" (FPS) video games are popular. In this study, we aimed to show that a novel in-house designed colonoscope controller used to play an FPS video game shares similar constructs with real-life endoscopy. MethodologyParticipants completed the first three levels on an FPS video game, Portal (Valve Corporation, Bellevue, WA), first using a conventional controller and then the modified endoscope controller. A total of 12 expert endoscopists and 12 surgical residents with minimal endoscopy experience were evaluated based on completion time, button presses, and hand motion analyses. ResultsExperts outperformed novices for completion time (expert: 944 seconds; novice: 1,515 seconds; p = 0.006) and hand movements (expert: 1,263.1; novice: 2,052.6; p = 0.004) in using the novel colonoscope controller. There was no difference in button presses or total path length traveled. Furthermore, performance did not differ using conventional game controls. ConclusionsExperts outperformed novices using the endoscope but not the conventional controller with respect to the economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar paradigms with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.

show abstract

“… In Ref. [ 28 ], a motion tracking setup to measure wrist and elbow joint motions is described in [ 28 ]. Several wrist and elbow motion metrics are described in this work.…”

Section: Related Workmentioning

confidence: 99%

Methods for Gastrointestinal Endoscopy Quantification: A Focus on Hands and Fingers Kinematics

Otero-González

Caeiro-Rodríguez

Rodríguez-D’Jesús

2022

Sensors

View full text Add to dashboard Cite

Gastrointestinal endoscopy is a complex procedure requiring the mastery of several competencies and skills. This procedure is in increasing demand, but there exist important management and ethical issues regarding the training of new endoscopists. Nowadays, this requires the direct involvement of real patients and a high chance of the endoscopists themselves suffering from musculoskeletal conditions. Colonoscopy quantification can be useful for improving these two issues. This paper reviews the literature regarding efforts to quantify gastrointestinal procedures and focuses on the capture of hand and finger kinematics. Current technologies to support the capture of data from hand and finger movements are analyzed and tested, considering smart gloves and vision-based solutions. Manus VR Prime II and Stretch Sense MoCap reveal the main problems with smart gloves related to the adaptation of the gloves to different hand sizes and comfortability. Regarding vision-based solutions, Vero Vicon cameras show the main problem in gastrointestinal procedure scenarios: occlusion. In both cases, calibration and data interoperability are also key issues that limit possible applications. In conclusion, new advances are needed to quantify hand and finger kinematics in an appropriate way to support further developments.

show abstract

Objective assessment of colonoscope manipulation skills in colonoscopy training

Abstract: We have developed and implemented a hand and joint motion analysis system that is able to discriminate novices from experts based on objective measures of motion. These metrics could, thus, serve as proxies for technical proficiency during training.

Cited by 4 publications

References 31 publications

Analyzing colonoscopy training learning curves using comparative hand tracking assessment

Analyzing colonoscopy training learning curves using comparative hand tracking assessment

Design and Validity Evidence for a Unique Endoscopy Simulator Using a Commercial Video Game

Methods for Gastrointestinal Endoscopy Quantification: A Focus on Hands and Fingers Kinematics

Contact Info

Product

Resources

About