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Objective Evaluation of Sonographic Skill in Focussed Assessment with Sonography for
Trauma (FAST) Examinations
Matthew S. Holden1, Tamas Ungi1, Conor McKaigney2, Colin Bell2, Louise Rang2, Gabor Fichtinger1
1Laboratory for Percutaneous Surgery, Queen’s University, Kingston, Canada2Department 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
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Spleen(perisplenic)
Heart(pericardial)
Liver/Kidney(perihepatic)
Bladder(pelvic)
FAST Examination
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Negative FAST Examination Positive FAST Examination
http://www.sonoguide.com/FAST.html
Objective
Devise a method for objectively evaluating sonographic skill in FAST examinations.
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Interventional Skill EvaluationNeedle-Based Intervention
Skill EvaluationLaparoscopic
Skill Evaluation
Anatomy Plastic phantom Box trainer orVirtual reality
Skill Evaluation Motion economy metrics Motion economy metrics
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(Keri et al. 2015, CJA) (Stylopoulos et al. 2004, Surg Endosc)
Sonographic Skill EvaluationSonographic
Skill Evaluation
Anatomy Human Volunteer
Skill Evaluation
Motion economy metrics +Scan completeness metric
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Scan Completeness Metric
• Anatomical points of interest (POIs)
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Expert Scan: Defining POIs
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Trainee Scan: Checking if POIs Scanned
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Experimental Setup
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Probe
Image
Reference
Tracker
Volunteer
Ultrasoundmachine
Recordingcomputer
Experimental Setup
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Perk Tutor
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(Ungi et al. 2012, IEEE TBME)
• Open-source surgical training platform• Data visualization• Automatic feedback
& skill evaluation
www.perktutor.org
Ultrasound-guided facet joint injection
Ultrasound-guided nephrostomy
Objective Skill Metrics
• Motion economy metrics:– Time– Probe path length
• Scan completeness metrics:– Percentage of POIs scanned
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Expert
Determine POIs from expert scan
Novice Group (N=14)
Intermediate Group (N=15)
Experimental Design
Liver/Kidney Spleen Heart Bladder
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Liver/Kidney Spleen Heart Bladder
Liver/Kidney Spleen Heart Bladder
Results: Overall
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Time (s)(p < 0.001)
Path Length (mm)(p < 0.001)
POIs Scanned (%)(p < 0.001)
Results: POIs Scanned (%)
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Live
r/Ki
dney
(p <
0.0
01)
Hea
rt (p
= 0
.27)
Sple
en (p
< 0
.001
)Bl
adde
r (p
= 0.
008)
Conclusion
• Proposed scan completeness metric correlates with skill (validation)
• Sonographic skill evaluation with open-source components
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Thank You!
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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.
Contact: Matthew Holden ([email protected])
PerkTutor: www.perktutor.org
