Surgical Skill Can be Objectively Measured From Fluoroscopic Images Using a Novel Image-based Decision Error Analysis...

Area of Science:

• Orthopaedic Surgery
• Medical Imaging
• Surgical Skill Assessment

Background:

• Objective performance measures are needed to advance orthopaedic surgical skills training.
• The tip-apex distance in hip fracture repair lacks process-based skill assessment.
• This study introduces the Image-based Decision Error Analysis (IDEA) score for fluoroscopically-assisted wire navigation.

Purpose of the Study:

• To objectively measure wire navigation skill using fluoroscopic images.
• To determine if simulated skill behaviors translate to the operating room.
• To define an objective skill metric that improves with surgical experience.

Main Methods:

• Evaluated performance on a hip fracture wire navigation simulator and in actual surgeries.
• Analyzed fluoroscopic image sequences from 176 simulator trials and 21 surgical procedures.
• Developed the IDEA score by measuring decision errors (off-target adjustments, drilling) and correlating with experience.

Main Results:

• The IDEA methodology analyzed over 37,000 images, identifying decision errors correlated with image count (R2=0.76 simulator, R2=0.71 OR).
• Decision errors did not correlate with tip-apex distance (R2=0.08 simulator, R2=0.03 OR), indicating independence.
• The IDEA composite score strongly correlated with surgical experience (R2=0.66).

Conclusions:

• Fluoroscopic images provide rich data for objective surgical skill assessment.
• The IDEA score offers a potential educational tool for resident training and feedback.
• Future research should apply this methodology to diverse fluoroscopically-guided procedures.