Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program

Uta Hanning; Matthias Bechstein; Johannes Kaesmacher; Grégoire Boulouis; René Chapot; Tommy Andersson; Edoardo Boccardi; Marios Psychogios; Christophe Cognard; Marta de Dios Lascuevas; Marta Rodrigues; Isabel Rodriguez Caamaño; Sergios Gargalas; Davide Simonato; Vedran Zupancic; Cornelia Daller; Lukas Meyer; Gabriel Broocks; Helena Guerreiro; Jens Fiehler; Mario Martínez-Galdamez; Vladimir Kalousek

doi:10.1007/s00062-022-01192-9

Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program

Clin Neuroradiol. 2023 Mar;33(1):137-145. doi: 10.1007/s00062-022-01192-9. Epub 2022 Jul 13.

Authors

Uta Hanning¹, Matthias Bechstein², Johannes Kaesmacher³, Grégoire Boulouis⁴, René Chapot⁵, Tommy Andersson^{6

7}, Edoardo Boccardi⁸, Marios Psychogios⁹, Christophe Cognard¹⁰, Marta de Dios Lascuevas¹¹, Marta Rodrigues¹², Isabel Rodriguez Caamaño¹³, Sergios Gargalas¹⁴, Davide Simonato¹⁵, Vedran Zupancic¹⁶, Cornelia Daller¹⁷, Lukas Meyer², Gabriel Broocks², Helena Guerreiro², Jens Fiehler², Mario Martínez-Galdamez¹⁸, Vladimir Kalousek¹⁶

Affiliations

¹ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. u.hanning@uke.de.
² Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
³ Department of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland.
⁴ Diagnostic and Interventional Neuroradiology Department, Institut national de la santé et de la recherche médicale (INSERM) Team 1253 iBrain, Tours University Hospital, Tours, Centre Val de Loire Region, France.
⁵ Department of Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany.
⁶ Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
⁷ Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium.
⁸ Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy.
⁹ Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland.
¹⁰ Neuroradiology Department, Pierre-Paul-Riquet/Purpan University Hospital, Toulouse, France.
¹¹ Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
¹² Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
¹³ Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
¹⁴ Diagnostic and Interventional Neuroradiology Department, John Radcliffe Hospital, Oxford, UK.
¹⁵ Interventional Neuroradiology Department, University Hospital of Padua, Padua, Italy.
¹⁶ Department of Radiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
¹⁷ Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria.
¹⁸ Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.

Abstract

Background: Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure.

Methods: During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course.

Results: A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6).

Conclusion: Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.

Keywords: Neuroendovascular training; Stroke; Telemedicine; Teleobservership; Teleproctoring.

MeSH terms

Europe
Fellowships and Scholarships*
Germany
Humans