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Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation
Dominik D Mattioli1, Geb W Thomas1,2, Steven Long2,3
1Department of Industrial and Systems Engineering, University of Iowa, Iowa City, Iowa, USA.
Summary
Objective analysis of surgical wire navigation using fluoroscopic images can evaluate psychomotor skills. Inefficient behaviors, like adjustments away from the goal, correlate with expert opinions and surgeon experience levels.
Area of Science:
- Medical Imaging
- Surgical Skill Assessment
- Biomedical Engineering
Background:
- Intraoperative fluoroscopic image sequences offer objective analysis of surgical wire navigation.
- Previous studies linked image-based behavior analysis to performer experience and expert opinion on implant quality.
- A gap exists in understanding how objective image-based evaluations compare to expert assessments of entire surgical performances.
Purpose of the Study:
- To examine the relationships between objective image-based criteria, expert opinions, and surgeon experience levels in wire navigation.
- To determine if objective metrics can explain expert preferences in surgical performance evaluation.
- To investigate the correlation of specific behaviors with objective scores, expert consensus, and experience.
Main Methods:
- A paired-comparison survey involving seven experts evaluating eight fluoroscopic wire navigation image sequences.
- Analysis of objective metrics reflecting psychomotor and decision-making behaviors, including image count, behavior tally, and adjustments away from goal.
- Statistical analysis to determine correlations (R-squared values) between objective criteria, expert consensus, and performer experience.
Main Results:
- Expert preferences were best explained by objective metrics of counter-productive behaviors, such as image count (R² = 0.83) and behavior tally (R² = 0.74).
- Adjustments away from goal showed a unique correlation with objective composite scores (R² = 0.40), expert consensus (R² = 0.76), and performer experience (R² = 0.41).
- Expert assessments, while reliable, did not significantly correlate with performer experience (R² = 0.11).
Conclusions:
- Experts perceive less efficient technical behavior as an indicator of lower technical proficiency.
- Objective image-based analysis effectively captures behaviors that experts associate with surgical skill.
- While expert opinions are consistent, they may not accurately reflect the actual experience level of the performing surgeon.
