The rapidly expanding application of carotid stenting, which was approved by the U.S. Food and Drug Administration (FDA) in September as an alternative to carotid endarterectomy (surgically removing plaque from the carotid artery), has brought to the forefront challenges involved in training physicians to perform these procedures. Could virtual reality (VR) training be a solution?
The results of a survey of 100 physicians who were trained to perform carotid angiography procedures via a VR system were announced at a poster session at the American College of Cardiology¹s 54th Annual Scientific Sessions in Orlando today and they bolster the idea that virtual reality may play an important role in carotid stenting training.
"Although carotid stenting is an exciting new technology which certainly offers high-risk patients a less invasive option with significantly fewer bad outcomes (heart attack, stroke and death) when compared to carotid endarterectomy, it also makes the physician¹s job more difficult because you can't see and feel tissues directly. Learning the hand-eye coordination of instruments, catheters and guide wires is problematic," says Emory Heart Center cardiologist Christopher Cates, MD, Director of Vascular Intervention at Emory University Hospital and Emory Crawford Long Hospital.
To lessen these difficulties, Dr. Cates and Anthony G. Gallagher, PhD, designed one of the first VR programs to train physicians in carotid stenting. Using simulators that look like human mannequins, physicians thread a catheter through an artificial circulatory system and view angiograms of the "patient."
Dr. Cates was part of the research team that surveyed the first 100 physicians who completed the Emory Neuro Anatomy Carotid Training (ENACT), a VR program using the Vascular Interventional System Trainer (VIST) for carotid angiography procedures. The majority of physicians who completed the VR training concluded that VIST looked, felt and behaved similar to working on an actual patient. "VIST represents one of the most sophisticated VR simulators in medicine. Overall, physicians reported that it was a good representation of the neck vasculature with appropriate pathology," Dr. Cates says. "They were very impressed with the catheter and wire dynamics which they reported gave a realistic feel of push-pull maneuvers involving catheters."
The physicians surveyed noted that some of the cranial bony structures and the intracranial vasculature correlated poorly with actual anatomic structures.
"Clearly, more work is required to validate whether this simulator will improve the physician's ability with catheter performance on actual patients," Dr. Cates says. "Historically, physicians have learned new procedures by first practicing on animals, cadavers or mechanical models, eventually receiving 'on-the-job training' by operating on patients under the guidance of experienced teachers. However, we believe this paradigm needs to change -- especially in the field of cardiovascular medicine -- and the results of the VR survey are very encouraging," Dr. Cates states. "We believe that practicing on patients will soon be a thing of the past."
In addition to Dr. Cates, the team of Emory investigators included Anthony G Gallagher, PhD; William J Nicholson, MD; Khusrow Niazi, MD; Tarek Helmy. MD; Puvi Seshiah, MD; and Anna Kalynych, MD.