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Objective: Assessing neuroradiologists' skills in the operating room (OR) is difficult and often subjective. This study used a workflow time-based task analysis approach while performing cerebral angiography., Methods: Eight angiographies performed by a senior neuroradiologist and eight performed by a junior neuroradiologist were compared. Dedicated software with specific terminology was used to record the tasks. Procedures were subdivided into phases, each comprising multiple tasks. Each task was defined as a triplet, associating an action, an instrument and an anatomical structure. The duration of each task was the metric. Total duration of the procedure, task duration and the number of times a task was repeated were identified. The focus was on tasks using fluoroscopy and for moving the X-ray table/tube., Results: The total duration of tasks to complete the entire procedure was longer for the junior operators than for the seniors (P=0.012). The mean duration per task during the navigation phase was 86s for the juniors and 43s for the seniors (P=0.002). The total and mean durations of tasks involving the use of fluoroscopy were also longer for the juniors (P=0.002 and P=0.033, respectively). For tasks involving the table/tube, the total and mean durations were again longer for the juniors (P=0.019 and P=0.082, respectively)., Conclusion: This approach allows reliable skill assessment in the radiology OR and comparison of junior and senior competencies during cerebral diagnostic angiography. This new tool can improve the quality and safety of procedures, and facilitate the learning process for neuroradiologists., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background and Purpose: Endovascular mechanical thrombectomy is emerging as a promising therapeutic approach for acute ischemic stroke. This study was aimed at identifying factors influencing outcomes after thrombectomy with a Solitaire stent device., Materials and Methods: Forty-five consecutive patients treated with thrombectomy using Solitaire FR were retrospectively included. Clinical, imaging and logistic variables were analyzed. A multivariate logistic regression analysis was used to identify variables influencing clinical outcome, based on discharge NIHSS score change and mRS at 3 months., Results: Patient mean age and initial NIHSS score was 58 years (range 24-88) and 17 (range 6-32), respectively. An MRI was performed for 80% of patients, showing severe DWI lesion for 28% of patients and associated FLAIR hyperintensity for 58% of patients. Mean time from symptom onset to recanalization was 299min for the 32 ACO and 473min for the 13 PCO. Angiographic efficacy (TICI 2b-3) was achieved for 93% of patients and good clinical outcomes at discharge and at 3 months (mRS≤2) were achieved for 49% and 58% of patients, respectively. Independent prognostic factors for predicting good clinical outcomes at discharge were a short time to recanalization and FLAIR negativity. At 3 months, they were a short time to recanalization and patient age. DWI lesion severity was an associated prognostic factor., Conclusion: Two main prognostic factors for predicting a good clinical outcome after thrombectomy at 3 months were short time from symptom onset to recanalization and patient age., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: Reducing radiation exposure through the use of low-dose protocols during cerebral endovascular procedures is recommended, but evaluation of the impact on the procedure itself is difficult and subjective. A workflow task analysis could provide an objective comparison of two different radiation exposure protocols., Subjects and Methods: Twenty endovascular aneurysm treatments were analyzed using a low-dose protocol (reducing radiation exposure by 20%) in 10 cases and a normal-dose protocol in the other 10 cases. The procedure was subdivided into five phases, each comprising a sequence of tasks. Each task was defined as a triplet, associating an action, an instrument, and an anatomic structure. A workflow editor was used to record tasks and phases with a tablet PC. The total duration of the entire procedure, the duration of each task, and the number of task repetitions were isolated and used as the metric. Moreover, the tasks involving x-ray use, essential for navigation and treatment phases, were separated and analyzed., Results: For the microcatheter navigation and treatment phases, no statistically significant difference was found between the two radiation exposure protocols. For guide catheter navigation in cervical vessels, the total phase duration and total and mean time of tasks specifically involving x-ray use increased with age, but there was no difference between the two radiation protocols., Conclusion: Workflow task analysis of endovascular aneurysm treatment shows no difference between low-dose and normal-dose protocols in the guide catheter navigation, microcatheter navigation, or treatment phases.