Metric-Based Virtual Reality Simulation

摘要

HomeStrokeVol. 49, No. 7Metric-Based Virtual Reality Simulation Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBMetric-Based Virtual Reality SimulationA Paradigm Shift in Training for Mechanical Thrombectomy in Acute Stroke Thomas Liebig, MD, PhD, Markus Holtmannspötter, MD, Robert Crossley, MRCS, Johan Lindkvist, MSc, Patrick Henn, MB, Lars Lönn, MD, PhD and Anthony G. Gallagher, PhD, DSc Thomas LiebigThomas Liebig From the Institute of Neuroradiology, Charité–Universitätsmedizin Berlin, Germany (T.L.) , Markus HoltmannspötterMarkus Holtmannspötter Department of Neuroradiology, Rigshospitalet, University of Copenhagen, Denmark (M.H.) , Robert CrossleyRobert Crossley Neuroradiology, North Bristol National Health Service Trust, Southmead Hospital, United Kingdom (R.C.) , Johan LindkvistJohan Lindkvist Mentice AB, Gothenburg, Sweden (J.L.) , Patrick HennPatrick Henn Medical Education, School of Medicine (P.H.) , Lars LönnLars Lönn University College Cork, Ireland; and Department of Cardiovascular Radiology, National Hospital, Copenhagen University, Denmark (P.L.). and Anthony G. GallagherAnthony G. Gallagher Correspondence to Anthony G. Gallagher, PhD, DSc, School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Rd, Ireland. E-mail E-mail Address: [email protected] Application of Science to Simulation-Based Education and Research on Training (ASSERT) Centre and School of Medicine (A.G.G.) Originally published30 Jul 2018https://doi.org/10.1161/STROKEAHA.118.021089Stroke. 2018;49:e239–e242Ischemic stroke is the second leading cause of death and the predominant cause of long-term disability in the Western world. Until recently, the standard treatment for ischemic stroke was intravenous administration of r-tPA (recombinant tissue-type plasminogen activator) within the accepted time limit of 4.5 hours from the onset of symptoms. Given later, risks such as intracranial hemorrhage outweigh the potential benefits. In large vessel occlusion (if no contraindication), r-tPA followed by mechanical thrombectomy improves outcomes. In a meta-analysis of large multicenter trials,1 patients receiving usual care (most often r-tPA) followed by mechanical thrombectomy showed significantly higher rates of functional independence at 90 days (46%) than those receiving usual care alone (26.5%). Benefits from mechanical thrombectomy have also been demonstrated in selected patient groups ≤162 and 24 hours3 after they were last known to be well.Despite the proven effectiveness of mechanical thrombectomy, access is limited. One of the main reasons is because of a shortage of interventional neuroradiologists trained to perform this procedure. Traditionally, doctors acquire their skills on new procedures on patients. However, image-guided procedures impose unique human factor challenges on the operator, which expose patients to potential risk during their learning curve. This current traditional process–driven approach to training4 (ie, procedure numbers done and time in training are assumed to signify skill) does not guarantee that the trained clinician has acquired the ability to effectively and readily execute as independent practitioners by the end of their training.5A novel approach to enhance the learning experience and training of doctors to competently perform mechanical thrombectomy is metric-based virtual simulation training to proficiency.5 A group of senior interventional neuroradiologists and the ASSERT Center at University College Cork, in conjunction with industry partner Mentice AB (Gothenburg, Sweden), have pioneered this method to help prepare physicians to perform this life-changing procedure.This vascular intervention system trainer (VIST) utilizes a physics-based high-fidelity endovascular virtual reality (VR) simulator, which enables