传统的徒手技术用于外部心室引流(EVD)放置是最常用的,但仍然是不准确的排水管放置的主要风险因素。由于此过程可以从图像指导中受益,作者阐述了与徒手技术相比,增强现实(AR)辅助对EVD放置准确性和学习曲线的影响.
16名医学生在定制的幻影头上总共进行了128次EVD放置,在接受标准化培训之前和之后。他们由写意技术或AR指导,它通过由内而外的红外跟踪为EVD放置提供了解剖学覆盖和量身定制的指导。结果通过EVD放置的度量准确性及其临床质量进行量化。
在与未经训练的徒手表现的直接比较中,平均目标误差受到AR(p=0.003)或训练(p=0.02)的显着影响。未经训练的(11.9±4.5mm)和经训练的(12.2±4.7mm)AR表现均明显优于未经训练的徒手表现(19.9±4.2mm),训练后有所改善(13.5±4.7mm)。通过改良的Kakarla量表(mKS)评估的EVD放置质量受到AR指导(p=0.005)而不是训练(p=0.07)的显着影响。未经训练和经过训练的AR表现(两者均为59.4%mKS1级)均显着优于未经训练的徒手表现(25.0%mKS1级)。空间能力测试显示感知能力与未经训练的AR指导表现之间存在相关性(r=0.63)。
与写意手法相比,对EVD放置的AR指导为程序新手提供了更高的结果准确性和质量。对于AR,未经训练的人表现得和受过训练的人一样好,这表明AR制导不仅提高了性能,而且对学习曲线也有积极影响。未来的工作将集中在临床环境中用于EVD放置的AR的翻译和评估。
The traditional freehand technique for external ventricular drain (EVD) placement is most frequently used, but remains the primary risk factor for inaccurate drain placement. As this procedure could benefit from image guidance, the authors set forth to demonstrate the impact of augmented-reality (AR) assistance on the accuracy and learning curve of EVD placement compared with the freehand technique.
Sixteen medical students performed a total of 128 EVD placements on a custom-made phantom head, both before and after receiving a standardized training session. They were guided by either the freehand technique or by AR, which provided an anatomical overlay and tailored guidance for EVD placement through inside-out infrared tracking. The outcome was quantified by the metric accuracy of EVD placement as well as by its clinical quality.
The mean target error was significantly impacted by either AR (p = 0.003) or training (p = 0.02) in a direct comparison with the untrained freehand performance. Both untrained (11.9 ± 4.5 mm) and trained (12.2 ± 4.7 mm) AR performances were significantly better than the untrained freehand performance (19.9 ± 4.2 mm), which improved after training (13.5 ± 4.7 mm). The quality of EVD placement as assessed by the modified Kakarla scale (mKS) was significantly impacted by AR guidance (p = 0.005) but not by training (p = 0.07). Both untrained and trained AR performances (59.4% mKS grade 1 for both) were significantly better than the untrained freehand performance (25.0% mKS grade 1). Spatial aptitude testing revealed a correlation between perceptual ability and untrained AR-guided performance (r = 0.63).
Compared with the freehand technique, AR guidance for EVD placement yielded a higher outcome accuracy and quality for procedure novices. With AR, untrained individuals performed as well as trained individuals, which indicates that AR guidance not only improved performance but also positively impacted the learning curve. Future efforts will focus on the translation and evaluation of AR for EVD placement in the clinical setting.