SIR 2024
Practice Development
Hamza Ali, MD (he/him/his)
Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Oussama Metrouh, MD (he/him/his)
Post- doctorate Research Fellow
Beth Israel Deaconess Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Sarah Schroeppel DeBacker, MD
Interventional Radiologist
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Colin McCarthy, MD
Instructor, Radiology, Harvard Medical School
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Muhammad Mohid Tahir, MD (he/him/his)
Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Christopher MacLellan, PhD
Physicist
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Matthew R. Palmer, PhD
Physicist
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Muneeb Ahmed, MD, FSIR
Chief, Division of Interventional Radiology; Professor
Beth Israel Deaconess Medical Center/Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Jeffrey Weinstein, MD FSIR
Program Director, Interventional Radiology Residency Programs
Beth Israel Deaconess Medical Center/Harvard Medical School
Disclosure information not submitted.
To evaluate the effect of being under time pressure on procedural performance using hand motion analysis.
Materials and Methods: Eight radiology trainees performed central venous access on a standardized phantom while recording video and hand motion data using an electromagnetic motion tracker. Each trainee performed the procedure 6 times. For the first 3 trials, they were asked to perform without any prompts (control), while for the next 3 trials, they were asked to perform the task as quickly as possible (time pressure). Validated hand motion metrics were analyzed. {1, 2} Two blinded and independent evaluators rated procedural performance using a previously validated task-specific Global Rating Scale (GRS). {3} Linear mixed-effect methods were used to individually model the motion metrics against the time taken for the procedure (fixed effect), with the participants acting as random effects. The constants were compared between the control and time pressure conditions. Wilcoxon signed-rank test was used to compare GRS scores between the control and time pressure performance of the trainees. Spearman correlation coefficients were calculated between the motion metric measurements and the validated global rating scale.
Results:
Data motion analysis showed that when placing the line quickly, the trainees completed the procedure faster (46 ± 18s vs. 56 ± 27s, p = 0.008) than during the control procedures. However, when holding time constant, trainees would move their hands 78 more centimeters (p = 0.048), and use 15 more translational movements (0.003) and 18 more rotational movements (p = 0.01) under time pressure compared to the control condition. The inter-rater reliability of the GRS scores between evaluators had a Kappa coefficient of 0.12 (95 % CI = -0.08, 0.33). Wilcoxon signed-rank tests showed no difference in GRS scores between control and time pressure performance (p=0.11). Spearman correlation between mean GRS and motion metrics showed a weak correlation (rho values ranging from -0.25 to -0.52).
Conclusion: Although trainees could perform the procedure faster under time pressure, motion metrics worsened relative to the time taken for the procedure. Hand motion analysis could detect this degradation in technical performance that was not captured using visual observation. This highlights the importance of hand motion analysis in providing an additional objective evaluation of procedural proficiency beyond measuring procedure time alone. This also suggests that trainees trying to perform a procedure emphasizing speed may degrade their technical performance.