Review article
Interventional Radiology Simulation: Prepare for a Virtual Revolution in Training

https://doi.org/10.1016/j.jvir.2006.11.005Get rights and content

It is becoming increasingly difficult to learn interventional radiology (IR) skills because there are fewer “straightforward” invasive diagnostic imaging studies, a reduction in the time available for training, concerns about patient safety, and changing patient perceptions. Computer-based simulation has the potential to allow an operator to realistically perform a virtual procedure with feedback about performance and could remove at least some of the patient’s role during the learning curve. To do this effectively requires a strategy for integrating simulator models into curricula and the development of standards for their validation.

Section snippets

Technology

A computer-based simulator model provides an operator with a facility to interact with a range of data sets derived from medical imaging. These virtual worlds or virtual environments (VEs) display variable anatomy and pathology, which are supplemented where necessary by medical illustration (19). VEs have been developed by industry (20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30) and by a number of academic groups (31, 32, 33, 34, 35, 36, 37, 38), with some providing a facility to upload patient

Performance Assessment

To provide legitimate evidence for award of a certification by a statutory body, an assessment process should follow content that is in keeping with the discipline’s curriculum (52). The methodology used should apply to a range of test scenarios and be unbiased, reproducible, cost effective, feasible, and objective (53). Objective assessment of skills is of increasing importance for certification in surgery. For example, observer-based checklists and global scoring systems have been evaluated

Validation

There is a need for some proof of the effectiveness, or validity, of simulated training tasks or test items and of any complete procedures and their assessment methodologies. For training purposes alone, however, it is necessary to validate only that part of the simulation being used for training.

A commonly performed and important study of validity is face validity, in which the test should appear to test takers to resemble the real-world task (how much does it look like the real thing?).

How to Adopt The Technology?

Currently, simulators are expensive. In due course, however, as with all technology, the costs for software and hardware should decrease. In addition, there is a trade-off of fidelity against cost that is likely to remain, at least for some time. The realism of a simulation should therefore be tailored to its purpose: If a low-fidelity simulation is sufficient to meet a particular training objective, it can, and indeed should, be used. Costs could also be contained by means of lease hire

Summary

For IR, the apprenticeship training method has become a defective and costly anachronism. Simulation, however, offers an alternative for at least some of the skills currently learned in patients. Although existing catheter-based simulations are suitable for understanding the procedure steps and the use of instruments, disparity often exists between their content and the training goals of specific curricula. Close collaboration between human factors experts, clinicians, educators, certifying

Acknowledgments

I am most grateful to Bill Lewandowski, MS (William E. Lewandowski Consulting, WV), Professor Nigel John, PhD, and Franck Vidal (Department of Informatics, University of Wales, Bangor) for their review, expertise, and insightful and invaluable comments about this manuscript.

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    Supported by the Royal College of Radiologists X-appeal Fund (2003). The author has identified no conflicts of interest.

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