Objective Evaluation of Sonographic Skill in Focussed Assessment

Objective Evaluation of Sonographic Skill in Focussed Assessment with Sonography for Trauma (FAST) Examinations Matthew S. Holden 1, Tamas Ungi 1, Conor Mc. Kaigney 2, Colin Bell 2, Louise Rang 2, Gabor Fichtinger 1 1 Laboratory for Percutaneous Surgery, Queen’s University, Kingston, Canada 2 Department of Emergency Medicine, Queen’s University, Kingston, Canada We acknowledge the funding support from the ISCAS student travel scholarship.

FAST Examination • Diagnostic examination for internal bleeding Heart (pericardial) Spleen (perisplenic) Liver/Kidney (perihepatic) Bladder (pelvic) Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 -2 -

FAST Examination Negative FAST Examination Positive FAST Examination http: //www. sonoguide. com/FAST. html Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 -3 -

Objective Devise a method for objectively evaluating sonographic skill in FAST examinations. Laboratory for

Interventional Skill Evaluation Needle-Based Intervention Skill Evaluation Laparoscopic Skill Evaluation Anatomy Plastic phantom Box trainer or Virtual reality Skill Evaluation Motion economy metrics (Keri et al. 2015, CJA) (Stylopoulos et al. 2004, Surg Endosc) Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 -5 -

Sonographic Skill Evaluation Anatomy Human Volunteer Skill Evaluation Motion economy metrics + Scan completeness metric Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 -6 -

Scan Completeness Metric • Anatomical points of interest (POIs) Laboratory for Percutaneous Surgery (The

Expert Scan: Defining POIs Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright ©

Trainee Scan: Checking if POIs Scanned Laboratory for Percutaneous Surgery (The Perk Lab) –

Experimental Setup Ultrasound machine Tracker Probe Volunteer Image Reference Recording computer Laboratory for Percutaneous

Experimental Setup Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University,

Perk Tutor Ultrasound-guided nephrostomy www. perktutor. org • Open-source surgical training platform • Data visualization • Automatic feedback & skill evaluation Ultrasound-guided facet joint injection (Ungi et al. 2012, IEEE TBME) Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 - 12 -

Objective Skill Metrics • Motion economy metrics: – Time – Probe path length • Scan completeness metrics: – Percentage of POIs scanned Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 - 13 -

Experimental Design Expert Liver/Kidney Spleen Heart Bladder Determine POIs from expert scan Novice Group (N=14) Liver/Kidney Spleen Heart Bladder Intermediate Group (N=15) Liver/Kidney Spleen Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 - 14 -

Results: Overall Time (s) (p < 0. 001) Path Length (mm) (p < 0.

Liver/Kidney (p < 0. 001) Spleen (p < 0. 001) Heart (p = 0. 27) Bladder (p = 0. 008) Results: POIs Scanned (%) Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 - 16 -

Conclusion • Proposed scan completeness metric correlates with skill (validation) • Sonographic skill evaluation with open-source components Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 - 17 -

Thank You! Contact: Matthew Holden (mholden 8@cs. queensu. ca) Perk. Tutor: www. perktutor. org Matthew S. Holden is funded by the ISCAS student scholarship for travel and the NSERC Canada Graduate Scholarship. Gabor Fichtinger is funded as a Cancer Care Ontario Research Chair in Cancer Imaging. Laboratory for Percutaneous Surgery (The Perk Lab) – Copyright © Queen’s University, 2015 - 18 -