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1. Continuous monitoring of surgical bimanual expertise using deep neural networks in virtual reality simulation

Author

Recai Yilmaz, Alexander Winkler-Schwartz, Nykan Mirchi, Aiden Reich, Sommer Christie, Dan Huy Tran, Nicole Ledwos, Ali M. Fazlollahi, Carlo Santaguida, Abdulrahman J. Sabbagh, Khalid Bajunaid, and Rolando Del Maestro

Subjects
Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Abstract In procedural-based medicine, the technical ability can be a critical determinant of patient outcomes. Psychomotor performance occurs in real-time, hence a continuous assessment is necessary to provide action-oriented feedback and error avoidance guidance. We outline a deep learning application, the Intelligent Continuous Expertise Monitoring System (ICEMS), to assess surgical bimanual performance at 0.2-s intervals. A long-short term memory network was built using neurosurgeon and student performance in 156 virtually simulated tumor resection tasks. Algorithm predictive ability was tested separately on 144 procedures by scoring the performance of neurosurgical trainees who are at different training stages. The ICEMS successfully differentiated between neurosurgeons, senior trainees, junior trainees, and students. Trainee average performance score correlated with the year of training in neurosurgery. Furthermore, coaching and risk assessment for critical metrics were demonstrated. This work presents a comprehensive technical skill monitoring system with predictive validation throughout surgical residency training, with the ability to detect errors.

Published
2022
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2. C-CASE 2022: Competence to Excellence01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment02. Barriers to surgical peer coaching — What have we learned, and where do we go from here?03. Shared decision-making and evidence-based medicine: Pivotal or trivial to patient care in orthopedic trauma?04. Immersive virtual reality and cadaveric bone are equally effective in skeletal anatomy education: a randomized crossover noninferiority trial05. Development of simulators for decentralized simulation-based education IO training using design thinking and Delphi — a novel approach06. The impact of feedback on laparoscopic skills for surgical residents during COVID-1907. The role of collaborative feedback and remote practice in the acquisition of suturing skills by medical students at Université de Montréal08. Efficacy testing of an affordable and realistic small bowel simulator for hand-sewn anastomosis09. The LASER rating scale: a new teaching tool in otolaryngology10. Virtual patient case simulations: their role in undergraduate and postgraduate surgical training11. Evaluating the effectiveness of video-assisted informed consent in surgery: a systematic review12. Communication patterns in the cardiac surgery operating room are affected by task difficulty: a simulation model13. Improving adherence to postcall departure guidelines in orthopedics: a quality-improvement initiative14. Increasing familiarity among team members helps to reduce laparoscopic procedure time15. The effectiveness of a self-directed online learning module on trainee knowledge and confidence during plastic surgery clinical rotations16. Implementing an orientation handbook before a surgical rotation in urology17. An examination of equity-related experiences of surgical trainees at academic centres across Ontario: design of a targeted needs assessment18. Viewing differences between experts and trainees: implication for surgical education19. Assessment of medical student exposure to and satisfaction with surgical subspecialty education20. Assessment of student exposure to climate impacts of surgical personal protective equipment in the undergraduate medical curriculum21. Virtual reality simulation for the middle cranial fossa approach — a face, content and construct validation study22. Evaluating the Canadian Orthopaedic Surgery Medical Education Course (COSMEC)23. Subpial resection in a novel ex vivo calf brain epilepsy simulation model24. Effectiveness of the Eyesi augmented reality simulator for ophthalmology trainees: a systematic review and meta-analysis25. Learning beyond the objectives: an evidence-based analysis of AI-selected competencies in surgical simulation training26. Virtual compared with in-person surgical grand rounds: participants’ perceptions, preferences and directions for the future27. Quality of narrative feedback for entrustable professional activities assessed in the operating room: analysis of 4. years of assessments in the surgical foundations curriculum at Queen’s University28. SimOscopy: an accessible 3D-printed and laser-cut laparoscopic surgical simulator developed for a mobile device29. A debriefing tool to acquire nontechnical skills in trauma courses30. Capacity building using a hub-and-spokes model to produce customizable simulators for surgical education31. Exploring skin tone diversity in a plastic surgery resident education curriculum32. Video-based assessments of thoracic surgery trainees’ operative skills as adjuncts in competency-based medical education33. How do you feel? An examination of team leaders’ and members’ emotions in surgical simulations34. Comparing the efficacy of a real-time intelligent coaching system to human expert instruction in surgical technical skills training: randomized controlled trial35. Empowering women to pursue surgery: launching a pilot gender-congruent mentorship program for medical students36. Affective and cognitive responses to a virtual reality spine simulator37. Immersive virtual reality for patient-specific preoperative planning: a systematic review38. The categorization of surgical problems by junior and senior medical students39. The application of microlearning modules in surgical education to enhance procedural skills and surgical training40. Authorship gender disparity and trends in female authorship in 5 high-impact orthopedic journals from 2002 to 202241. The landscape of Canadian academic surgery: analysis of gender representation, academic rank, and research productivity

Author

Stuti M. Tanya, Reva Qiu, Basmah AlTinawi, Mathew N. Hindi, Trisha Tee, Sheharzad Mahmood, Recai Yilmaz, Keerat Grewal, Nicole Stachura, Raahulan Rathagirishnan, Julia Micallef, Fabio Botelho, Stephanie Roberts, Rosephine Del Fernandes, Giuseppe Retrosi, Ali M. Fazlollahi, Lauren Carr, Nour Abou Hamdan, Anser Daud, Carolyn Lai, Sébastien Belliveau, Morgan S. Gold, Yao Zhang, Ishita Aggarwal, Ioana Fugaru, Pedram Akbari, Ajay Shah, Abigail White, Apoorva Bhandari, David Fleiszer, Ève Sédillot-Daniel, Florence Bénard, Florence Pelletier, Chelsea Harris, Mithusa Sivanathan, Dario Ferri, Jenny W. Jing, Sofia Valanci Aroesty, Lydia Goff, Helena Greene, Alexandra Munn, Andrew Furey, Nicholas Smith, Rhonda St. Croix, Susan Moffatt-Bruce, Guylaine Lefebvre, Edward J. Harvey, Rudolph Reindl, Hamid Al Badi, Gregory K. Berry, Paul A. Martineau, Robert Koucheki, Johnathan R. Lex, Alexandra Morozova, Tyler M. Hauer, Sarah Mirzaie, Peter C. Ferguson, Barbara Ballyk, Luz Yanguez Franco, Ian R. Drennan, Dale Button, Adam Dubrowski, Casey Thorburn, Claire Skanes, Robert Kennedy, Chris Smith, Andrei Torres, Léamarie Meloche-Dumas, Natasha Guérard-Poirier, Ahmad Kaviani, Bill Kapralos, Frédéric Mercier, Erica Patocskai, Merieme Habti, Simon Bérubé, Dominic Cadoret, Artur Arutiunian, Yasmina Papas, Antoine Melkane, Carlos Chiesa, Nicolas Fakhry, Vyvy Young, Libby Smith, Jerome Lechien, Louis Guertin, Marie-Jo Olivier, Anastasios Maniakas, R. Jun Lin, Éric Bissada, Apostolos Christopoulos, Tareck Ayad, Andrée-Anne Leclerc, Nancy Posel, Alicia Rosenzveig, Peter Gariscsak, Laryssa Kemp, Faizal Haji, Andrew Reid, Surita Sidhu, Michael Moon, Simon Turner, Bin Zheng, Jesse Isaac Wolfstadt, Jeremy Hall, Sarah Ward, Abdulrahman Jad, Nicholas Yee, Tayler Declan Ross, Peter Ferguson, Chantal Valiquette, Shakira Brathwaite, Greg Hawley, Glykeria Martou, Michael Hendry, Victoria Schouela, Mélanie Aubé-Peterkin, Andrea Winthrop, Morgan Gold, Justin T. Lui, Madeleine de Lotbiniere-Bassett, Joseph M. Chen, Vincent Y. Lin, Sumit K. Agrawal, Nikolas H. Blevins, Hanif M. Ladak, Farhad Pirouzmand, Tyler Hauer, Jesse Wolfstadt, Abdulrahman Almansouri, Mohammadreza Eskandari, Chinyelum Agu, Puja Pachchigar, Bianca Giglio, Neevya Balasubramniam, Houssem-Eddine Gueziri, Rolando Del Maestro, Tyler McKechnie, Amin Hatamnejad, Jenny Chan, Anne Beattie, Ahmad Alsayegh, Mohamad Bakhaidar, Rolando F. Del Maestro, Nafisa Dharamsi, Ingrid de Vries, Steve Mann, Laura McEwen, Timothy Phillips, Boris Zevin, Andrew Robart, Hannah Brennan, Joshua Conway, Christopher Patey, Jason Harley, Dan Poenaru, Krystina Clarke, Marie-Ève Roy, Stephane Bedwani, Érica Patocskai, Jane Zhu, Alexander Adibfar, Laura Snell, Rahul Nayak, Richard Malthaner, Dalilah Fortin, Richard Inculet, Mehdi Qiabi, Sayed Azher, Matthew Moreno, Lucia Patino Melo, Reinhard Pekrun, Jeffrey Wiseman, Gerald M. Fried, Susanne Lajoie, Ryan Brydges, Allyson Hadwin, Ning-Zi Sun, Elene Khalil, Jason M. Harley, Sarah Almas, Joanna Ryan, Blaire Anderson, Bilal Tarabay, Lucy Lan, Randi Mao, Jeffrey Kay, SA Darren de, Geoffrey Blair, Alborz Noorani, Sama Noorani, Megan Mak, George Ibrahim, Mojgan Hodaie, Katie van Kampen, Emily Domerchie, Patricia Farrugia, Maxine Joly-Chevrier, Anne Xuan-Lan Nguyen, Daiana Roxana Pur, Rebecca J. Power, Sanjay Sharma, Fiona Costello, and Femida Kherani

Subjects
Surgery
Published
2022

3. Suicidal Ideation and Attempts in Brain Tumor Patients and Survivors: A Systematic Review

Author

Mohammad Mofatteh, Mohammad Sadegh Mashayekhi, Saman Arfaie, Yimin Chen, Armaan K Malhotra, Mohammed Ali Alvi, Nicholas Sader, Violet Antonick, Mostafa Fatehi Hassanabad, Alireza Mansouri, Sunit Das, Xuxing Liao, Roger S McIntyre, Rolando Del Maestro, Gustavo Turecki, Aaron A Cohen-Gadol, Gelareh Zadeh, and Keyoumars Ashkan

Subjects
Oncology, Surgery, Neurology (clinical)
Abstract

Background Subsequent to a diagnosis of a brain tumor, psychological distress has been associated with negative effects on mental health as well as suicidality. The magnitude of such impact has been understudied in the literature. We conducted a systematic review to examine the impact of a brain tumor on suicidality (both ideation and attempts). Methods In accordance with the PRISMA guidelines, we searched for relevant peer-reviewed journal articles on PubMed, Scopus, and Web of Science databases from inception to October 20th, 2022. Studies investigating suicide ideation and/or attempt among patients with brain tumors were included. Results Our search yielded 1,998 articles which were screened for eligibility. Seven studies consisting of 204,260 patients were included in the final review. Four studies comprising 203,906 patients (99.8%) reported elevated suicidal ideation and suicide attempt incidence compared with the general population. Prevalence of ideation and attempts ranged from 6.0% to 21.5% and 0.03% to 3.33%, respectively. Anxiety, depression, pain severity, physical impairment, glioblastoma diagnosis, male sex, and older age emerged as the primary risk factors associated with increased risk of suicidal ideation and attempts. Conclusion Suicidal ideation and attempts are increased in patients and survivors of brain tumors compared to the general population. Early identification of patients exhibiting these behaviors is crucial for providing timely psychiatric support in neuro-oncological settings to mitigate potential harm. Future research is required to understand pharmacological, neurobiological, and psychiatric mechanisms that predispose brain tumor patients to suicidality.

Published
2023

4. Canadian Conference for the Advancement of Surgical Education (C-CASE) 2021: Post-Pandemic and Beyond Virtual Conference AbstractsBlended learning using augmented reality glasses during the COVID-19 pandemic: the present and the futureActivating emotions enhance surgical simulation performance: a cluster analysisTraining in soft-tissue resection using real-time visual computer navigation feedback from the Surgery Tutor: a randomized controlled trialSonoGames: delivering a point of care ultrasound curriculum through gamificationTeaching heart valve surgery techniques using simulators: a reviewPortable, adjustable simulator for cardiac surgical skillsDesign and validity evidence for a unique endoscopy simulator using a commercial video gameComparison of a novel silicone flexor tendon repair model to a porcine tendon repair modelAssessment system using deep learningChallenges addressed with solutions, simulation in undergraduate and postgraduate surgical education, innovative education or research in surgical educationMachine learning distinguishes between skilled and less-skilled psychological performance in virtual neurosurgical performanceA powerful new tool for learning anatomy as a medical studentDevelopment and effectiveness of a telementoring approach for neurosurgical simulation training of medical studentsA team based learning approach to general otolaryngology in undergraduate medical educationStudent-led surgery interest group outreach for high school mentorship: a diversity driven initiativeRetrospective evaluation of novel case-based teaching series for first year otolaryngology residentsHarassment in surgery: assessing differences in perceptionFactors associated with medical student interest in pursuing a surgical residency: a cross-sectional survey studyUnderstanding surgical education experiences: an examination of 2 mentorship modelsLeadership development programs for surgical residents: a narrative review of the literatureValidation of knee arthroscopy simulator scoring system against subjective video analysis scoringCharacterizing the level of autonomy in Canadian cardiac surgery residentsMentorship patterns among medical students successfully matched to a surgical specialityStaying safe with laparoscopic cholecystectomy: the use of landmarking and intraoperative time-outsEndovascular aneurysm repair has changed the training paradigm of vascular residentsImplementation of a standardized handover in pediatric surgeryProcedure-specific assessment in cardiothoracic and vascular surgery: a scoping reviewLongitudinal mentorship-based programs for junior medical students increases exposure, confidence, and interest in surgeryCreating a green-shift in surgical education: a scoping review of initiatives and methods to make perioperative care more sustainableA novel plastic surgery residency bootcamp: structure and utilityVideo-based coaching for surgical residents: a systematic review and meta-analysisVirtual patient cases aligned with EPAs provide innovative e-learning strategiesAchieving competency in the CanMEDS roles for surgical trainees in the COVID-19 era: What have we learned and where do we go?Profiles of burnout and response to the COVID-19 pandemic among general surgery residents at a large academic training programLearner-driven telemedicine curriculum during the COVID-19 pandemicCentralized basic orthopaedic surgery virtual examinations — assessment of examination environmentEffects of the COVID-19 pandemic on surgical resident training: a nationwide survey of Canadian program directorsExploring the transition to virtual care in surgery and its impact on clinical exposure, teaching, and assessment during the COVID-19 pandemiecImpact of COVID-19 on procedural skills training and career preparation of medical studentsVirtual surgical shadowing for undergraduate medical students amidst the COVID-19 pandemicEducational impact of the COVID-19 third wave on a competency-based orthopedic surgery programVirtualization of postgraduate residency interviews: a ransforming practice in health care educationAn informational podcast about Canadian plastic surgery training programs: 'Doctority Canada: Plastic Surgery.'Virtual versus in-person suture training: an evaluation of synchronous and asynchronous teaching paradigmsMerged virtual reality teaching of the fundamentals of laparoscopic surgery: a randomized controlled trialShould surgical skills be evaluated during virtual CaRMS residency interviews? A Canadian survey of CaRMS applicants and selection committee members during the COVID-19 pandemicImpact of the COVID-19 pandemic on surgical education for medical students: perspectives from Canada’s largest faculty of medicine

Author

Anser Daud, Rosephine Del Fernandes, Garrett Johnson, Peter Gariscsak, Shaishav Datta, Luckshi Rajendran, Jong Min Lee, Max Solish, Ishita Aggarwal, Jessica Ho, Eileen Roach, Valérie Lemieux, Scott Zablotny, May-Anh Nguyen, Gary Ko, Sam Minor, Ryan Daniel, Valérie Gervais, Yseult Gibert, David Lee, Abigail White, Victoria Lee-Wing, Saad Balamane, Shirley Xiaoxuan Deng, Jobanpreet Dhillon, Samuel Larrivée, Marina L. Parapini, Mahrukh Nisar, Michael Lee, Tristan Desrosiers, Lily Wang, Lina Elfaki, Fatemeh Ramazani, Ali M. Fazlollahi, Jonathan Hampshire, Sharif Natheir, Ge Shi, Recai Yilmaz, Veronique M. Doucet, Ryaan El-Andari, Danielle Arshinoff, Meredith Poole, Clarissa H.H. Lau, Zeeshan Ahmed, Brian Fahey, Adeel Zafar, Amy P. Worrall, Elrasheid Kheirelseid, Seamus McHugh, Daragh Moneley, Peter Naughton, Mohamad Bakhaidar, Ahmad Alsayegh, Rolando F. Del Maestro, Jason M. Harley, Tamas Ungi, Gabor Fichtinger, Boris Zevin, Eva Stolz, Sabin J. Bozso, Jimmy J.H. Kang, Corey Adams, Jeevan Nagendran, Dongjun Li, Simon R. Turner, Michael C. Moon, Bin Zheng, Ashley Vergis, Bertram Unger, Jason Park, Lawrence Gillman, Christian J. Petropolis, Alexander Winkler-Schwartz, Nykan Mirchi, Ali Fazlollahi, Rolando Del Maestro, Edward Wang, Ryan Waterman, Andrew Kokavec, Edward Ho, Kiera Harnden, Rahul Nayak, Richard Malthaner, Mehdi Qiabi, Sommer Christie, Alexander Winkler-Schwarz, Khalid Bajunaid, Abdulrahman J. Sabbagh, Penny Werthner, Ioana Bratu, Michelle Noga, David Côté, Lukas Mortensen-Truscott, Sean McKellar, Dan Budiansky, Jessica Henley, Justine Philteos, Alexander Gabinet-Equihua, Garret Horton, Marc Levin, Ahmed Saleem, Eric Monteiro, Vincent Lin, Yvonne Chan, Paolo Campisi, Léamarie Meloche-Dumas, Erica Patocskai, Adam Dubrowski, Michèle Beniey, Pamela Bélanger, Adree Khondker, Emilia Kangasjarvi, Jory Simpson, Abdollah Behzadi, Kerry Kuluski, Tracy M. Scott, Ravi Sidhu, Ahmer A. Karimuddin, Alisha Beaudoin, Sheila McRae, Jeff Leiter, Gregory Stranges, Devin O’Brien, Gurmeet Singh, Ali Salimi, Alice Zhu, Melanie Tsang, Brittany Greene, Shiva Jayaraman, Peter Brown, David Zelt, Michael Yacob, Richard Keijzer, Anna C. Shawyer, Hellmuth R. Muller Moran, Joanna Ryan, Brett Mador, Sandra Campbell, Simon Turner, Kelvin Ng, Yousra-Imane Benaskeur, Sara Medina Kasasni, Nissrine Ammari, Florence Chiarella, Jeanne Lavallée, Anne-Sophie Lê, Maria Alexandra Rosca, Koorosh Semsar-Kazerooni, Tharaniya Vallipuram, Detlev Grabs, Émilie Bougie, G. Emmanuel Salib, Patricia Bortoluzzi, Dominique Tremblay, Colin C. Kruse, Tyler McKechnie, Cagla Eskicioglu, Nancy Posel, David Fleiszer, David Berger-Richardson, Savtaj Brar, David W. Lim, Tulin D. Cil, Matthew Castelo, Justin Lu, Emma Reel, Tulin Cil, Sebastian Diebel, Madeleine Nolan, Dana Bartolucci, Mathieu Rheault-Henry, Emmanuel Abara, Jonathan Doyon, Douglas Archibald, Veronica Wadey, Azusa Maeda, Timothy Jackson, Allan Okrainec, Rebecca Leclair, Heather Braund, Jennifer Bunn, Ekaterina Kouzmina, Samantha Bruzzese, Sara Awad, Steve Mann, Ramana Appireddy, Kiera Liblik, Andrea Winthrop, Bryan Abankwah, Michael Weinberg, Ahmed Cherry, Valerie Lemieux, Stan Hamstra, Markku Nousiainen, Wanda Marini, Ashlie Nadler, Wafa Khoja, Jenna Stoehr, Bryce Lowy, Nicole Relke, Eleftherios Soleas, Janet Lui, Melinda Musgrave, Rob Stewart, and Jeremy Hall

Subjects
Surgery
Published
2021

7. Utilizing artificial intelligence and electroencephalography to assess expertise on a simulated neurosurgical task

Author

Sharif Natheir, Sommer Christie, Recai Yilmaz, Alexander Winkler-Schwartz, Khalid Bajunaid, Abdulrahman J. Sabbagh, Penny Werthner, Jawad Fares, Hamed Azarnoush, and Rolando Del Maestro

Subjects
Health Informatics, Computer Science Applications
Abstract

Virtual reality surgical simulators have facilitated surgical education by providing a safe training environment. Electroencephalography (EEG) has been employed to assess neuroelectric activity during surgical performance. Machine learning (ML) has been applied to analyze EEG data split into frequency bands. Although EEG is widely used in fields requiring expert performance, it has yet been used to classify surgical expertise. Thus, the goals of this study were to (a) develop an ML model to accurately differentiate skilled and less-skilled performance using EEG data recorded during a simulated surgery, (b) explore the relative importance of each EEG bandwidth to expertise, and (c) analyze differences in EEG band powers between skilled and less-skilled individuals. We hypothesized that EEG recordings during a virtual reality surgery task would accurately predict the expertise level of the participant. Twenty-one participants performed three simulated brain tumor resection procedures on the NeuroVR™ platform (CAE Healthcare, Montreal, Canada) while EEG data was recorded. Participants were divided into 2 groups. The skilled group was composed of five neurosurgeons and five senior neurosurgical residents (PGY4-6), and the less-skilled group was composed of six junior residents (PGY1-3) and five medical students. A total of 13 metrics from EEG frequency bands and ratios (e.g., alpha, theta/beta ratio) were generated. Seven ML model types were trained using EEG activity to differentiate between skilled and less-skilled groups. The artificial neural network achieved the highest testing accuracy of 100% (AUROC = 1.0). Model interpretation via Shapley analysis identified low alpha (8-10 Hz) as the most important metric for classifying expertise. Skilled surgeons displayed higher (p = 0.044) low-alpha than the less-skilled group. Furthermore, skilled surgeons displayed significantly lower TBR (p = 0.048) and significantly higher beta (13-30 Hz, p = 0.049), beta 1 (15-18 Hz, p = 0.014), and beta 2 (19-22 Hz, p = 0.015), thus establishing these metrics as important markers of expertise. ACGME CORE COMPETENCIES: Practice-Based Learning and Improvement.

Published
2021

9. Nondominant Hand Skills Spatial and Psychomotor Analysis During a Complex Virtual Reality Neurosurgical Task-A Case Series Study

Author

Recai Yilmaz, Nicole Ledwos, Robin Sawaya, Alexander Winkler-Schwartz, Nykan Mirchi, Vincent Bissonnette, Ali M. Fazlollahi, Mohamad Bakhaidar, Ahmad Alsayegh, Abdulrahman J. Sabbagh, Khalid Bajunaid, and Rolando Del Maestro

Subjects
Neurosurgeons, Brain Neoplasms, Neurosurgery, Virtual Reality, Humans, Surgery, Neurology (clinical), Simulation Training
Abstract

Virtual reality surgical simulators provide detailed psychomotor performance data, allowing qualitative and quantitative assessment of hand function. The nondominant hand plays an essential role in neurosurgery in exposing the operative area, assisting the dominant hand to optimize task execution, and hemostasis. Outlining expert-level nondominant hand skills may be critical to understand surgical expertise and aid learner training.To (1) provide validity for the simulated bimanual subpial tumor resection task and (2) to use this simulation in qualitative and quantitative evaluation of nondominant hand skills for bipolar forceps utilization.In this case series study, 45 right-handed participants performed a simulated subpial tumor resection using simulated bipolar forceps in the nondominant hand for assisting the surgery and hemostasis. A 10-item questionnaire was used to assess task validity. The nondominant hand skills across 4 expertise levels (neurosurgeons, senior trainees, junior trainees, and medical students) were analyzed by 2 visual models and performance metrics.Neurosurgeon median (range) overall satisfaction with the simulated scenario was 4.0/5.0 (2.0-5.0). The visual models demonstrated a decrease in high force application areas on pial surface with increased expertise level. Bipolar-pia mater interactions were more focused around the tumoral region for neurosurgeons and senior trainees. These groups spent more time using the bipolar while interacting with pia. All groups spent significantly higher time in the left upper pial quadrant than other quadrants.This work introduces new approaches for the evaluation of nondominant hand skills which may help surgical trainees by providing both qualitative and quantitative feedback.

Published
2021

10. Neurosurgery Case Review: Questions and Answers

Author

Christian A. Bowers, Flavio Giordano, Faisal Abdulhamid Farrash, Pascal M. Jabbour, Alan Siu, Ramez Malak, Donald C. Shields, Unwar Ul-Haq, Jared J. Marks, Francisco Sanz, Achal Patel, Edward C. Benzel, Nabeel S. Alshafai, Hasel W. Slone, Jason S. Goldberg, Fahad Eid Alotaibi, Mohammad Almubaslat, Kamlesh B. Patel, Glenn C. Hunter, Anna Zicca, Michel Lacroix, Ibrahim Althubaiti, H. Francis Farhadi, Ahmed Mohyeldin, Robert L. Tiel, Homoud Aldahash, Claude-Edouard Châtillon, Franco DeMonte, Ossama Al-Mefty, Roberto Rafael Herrera, Nicholas J. Erickson, Nazer H. Qureshi, André Beer-Furlan, Judith Marcoux, Abdulrahman Yaqub Alturki, Ahmed Alaqeel, Badih Daou, Turki Elarjani, Sandeep Mittal, Kathleen E. Knudson, Alvin Chan, Amin B. Kassam, Kelsey A. Walsh, Mohammed Alghamd, Alfio Spina, Richard Bucholz, Fred Gentili, Marguerite Harding, Ricardo L. Carrau, Alwin Camacho, Pablo González-López, Faisal Al-Otaibi, Cristian Gragnaniello, Abdulrahman J. Sabbagh, Asem Salma, Stephen J. Hentschel, Joung H. Lee, Fahad AlKherayf, Rory Mayer, Rihaf Algain, John Woulfe, Stephen M. Russell, Han Zhuang Beh, Perry S. Bradford, Andrew Smith, Frederick Boop, Jorge E. Isaza, Vishal Patel, Eddie Perkins, Abdulrahman Albakr, Ibrahim Omeis, Christopher D. Baggott, Kevin Petrecca, Bassem Yousef Sheikh, Shaymaa Al-Umran, Michele Bailo, Jonathon Lebovitz, Pratap Chand, Edgar Gerardo Ordóñez-Rubiano, Aaron S. Gaekwad, Mohammed Almekhlafi, Jonathan Yun, Dimitri Sigounas, Julius July, Joseph A. Shehadi, Gustavo D. Luzardo, Ennio Antonio Chiocca, Shaan M. Raza, Alberto L. Gallotti, Anup Aggarwal, Ali Luqman, Mohammad A. Aziz-Sultan, Isabella Esposito, Eka Julianta Wahjoepramono, Imad N. Kanaan, Abdulrazag Ajlan, Hosam Al-Jehani, Brian Gill, Jaime Gasco, Brian Seaman, William T. Couldwell, José Luis Ledesma, Gary L. Gallia, Ananth K. Vellimana, Mark G. Hamilton, Da’Marcus Baymon, Almunder Algird, Evan S. Marlin, Ahmad I. Lary, Rudiger Von Ritschl, Afnan Uthman Alkhotani, Kevin Phan, Ayman Abdullah Albanyan, Essam A. Al Shail, Joshua Loewenstein, Mohammad Misfer Alshardan, Denis Klironomos, Ehtesham Ghani, Hector P. Rojas, Jeffery Atkinson, Matthew D. Smyth, Eldad J. Hadar, Erol Veznedaroglu, Mark A. Mahan, Qasim Al Hinai, Iván Verdú-Martínez, Peter J. Mews, Mohamed A. Labib, Randy L. Jensen, Rahul Shah, Amal Mokeem, Rolando Del Maestro, Denis Sirhan, Albert M. Isaacs, José Luis Montes, Mariam Alrashid, Jason Tullis, Hussam Abou-Al-Shaar, Justin Reagan, Daniel S. Ikeda, Pietro Mortini, David Sinclair, Hubert Lee, Mazda K. Turel, Michael S. Taccone, Alexander Y. Lin, Stephano Chang, Patrick Kim, Paul Steinbok, Luke G. F. Smith, Sami Obaid, Ashwag Al-Qurashi, Andrew Shaw, Abdul Haseeb Naeem, Exequiel P. Verdier, Ahmed Jaman Alzahrani, Lahbib A. Soualmi, Remi Nader, Ralph J. Mobbs, Soha Abdu M. Alomar, Mohammed Saeed Bafaqeeh, Zachary N. Litvack, Weston T. Northam, Joaquin Hidalgo, Robert F. Keating, Amgad S. Hanna, Jared Fridley, Bassam M. J. Addas, Monish Maharaj, Diana Ghinda, Daniel M. Prevedello, John S. Myseros, Lorenzo Genitori, Layla Batarfi, Khalid N. Almusrea, Samer K. Elbabaa, Adam Sauh Gee Wu, Anthony M. T. Chau, Naif M. Alotaibi, Saleh S. Baeesa, Kimberly Hamilton, Franz L. Ricklefs, Hashem Al Hashemi, Lissa Marie Peeling, Gareth Rutter, Sohum Desai, Philippe Mercier, Daniel Branch, Jorge E. Alvernia, Craig C. Weinkauf, Sunil Kukreja, Michel W. Bojanowski, Paul W. Gidley, Reem Bunyan, Domenic P. Esposito, Salah Baz, Randall C. Edgell, Christopher Evan Stewart, Burak Sade, Frank Gerold, Ali Alwadei, Nancy McLaughlin, Christopher J. Winfree, Terence Verla, Marc-Elie Nader, Andrew Jea, Filippo Gagliardi, Jean-Pierre Farmer, Giuliana Rizzo, Jeffrey P. Mullin, Ahmed T. Abdelmoity, Eric P. Roger, Anish Sen, Ivona Nemeiko, Mahmoud AlYamany, Anthony J. Caputy, Peter Nakaji, Nirmeen Zagzoog, Charles B. Agbi, Khalid Bajunaid, Matthew Pierson, Juan Ortega-Barnett, Justine Pearl, Maqsood Ahmad, Abdulmajeed Alahmari, and Robert A. Moumdjian

Subjects
Questions and answers, medicine.medical_specialty, Medical education, business.industry, medicine, Neurosurgery, business, Neuroscience, Case review
Published
2020

11. Development of the McGill Simulator for Endoscopic Sinus Surgery: A New High-fidelity Virtual Reality Simulator for Endoscopic Sinus Surgery

Author

Rickul, Varshney, Saul, Frenkiel, Lily H P, Nguyen, Meredith, Young, Rolando, Del Maestro, Anthony, Zeitouni, Marc A, Tewfik, and R, DiRaddo

Subjects
medicine.medical_specialty, Virtual reality simulator, MEDLINE, technical abilities, Otolaryngology, Paranasal Sinuses, Humans, Immunology and Allergy, Medicine, resident, rhinology, Computer Simulation, minimally invasive surgery, education, training, Modalities, business.industry, nasal model, General surgery, Internship and Residency, Endoscopy, General Medicine, performance metrics, simulation, Surgery, Endoscopic sinus surgery, Otorhinolaryngology, virtual reality, haptic, Clinical Competence, Clinical competence, business, endoscopic sinus surgery
Abstract

Background The technical challenges of endoscopic sinus surgery (ESS) and the high risk of complications support the development of alternative modalities to train residents in these procedures. Virtual reality simulation is becoming a useful tool for training the skills necessary for minimally invasive surgery; however, there are currently no ESS virtual reality simulators available with valid evidence supporting their use in resident education. Our aim was to develop a new rhinology simulator, as well as to define potential performance metrics for trainee assessment. Methods The McGill simulator for endoscopic sinus surgery (MSESS), a new sinus surgery virtual reality simulator with haptic feedback, was developed (a collaboration between the McGill University Department of Otolaryngology–Head and Neck Surgery, the Montreal Neurologic Institute Simulation Lab, and the National Research Council of Canada). A panel of experts in education, performance assessment, rhinology, and skull base surgery convened to identify core technical abilities that would need to be taught by the simulator, as well as performance metrics to be developed and captured. Results The MSESS allows the user to perform basic sinus surgery skills, such as an ethmoidectomy and sphenoidotomy, through the use of endoscopic tools in a virtual nasal model. The performance metrics were developed by an expert panel and include measurements of safety, quality, and efficiency of the procedure. Conclusion The MSESS incorporates novel technological advancements to create a realistic platform for trainees. To our knowledge, this is the first simulator to combine novel tools such as the endonasal wash and elaborate anatomic deformity with advanced performance metrics for ESS.

Published
2014

12. Validation of a hybrid Doppler ultrasound vessel-based registration algorithm for neurosurgery

Author

D. Rolando Del Maestro, Sean Jy-Shyang Chen, Laurence Mercier, Charles X. B. Yan, Pierrick Coupé, D. Louis Collins, Ingerid Reinertsen, McConnell Brain Imaging Centre (MNI), Montreal Neurological Institute and Hospital, McGill University = Université McGill [Montréal, Canada]-McGill University = Université McGill [Montréal, Canada], Stiftelsen for INdustriell og TEknisk Forskning Digital [Trondheim] (SINTEF Digital), Laboratoire Bordelais de Recherche en Informatique (LaBRI), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure d'Électronique, Informatique et Radiocommunications de Bordeaux (ENSEIRB), and McGill University = Université McGill [Montréal, Canada]

Subjects
Male, MESH: Magnetic Resonance Angiography, 02 engineering and technology, Neurosurgical Procedures, 030218 nuclear medicine & medical imaging, Intraoperative Period, 0302 clinical medicine, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, 0202 electrical engineering, electronic engineering, information engineering, Computer vision, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, Phantoms, Imaging, Brain, General Medicine, Middle Aged, Computer Graphics and Computer-Aided Design, Computer Science Applications, [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], Preoperative Period, cardiovascular system, MESH: Neuronavigation, 020201 artificial intelligence & image processing, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Computer Vision and Pattern Recognition, Algorithm, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Algorithms, Adult, Biomedical Engineering, Health Informatics, MESH: Algorithms, MESH: Preoperative Period, Article, 03 medical and health sciences, MESH: Brain, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Radiology, Nuclear Medicine and imaging, Neuronavigation, Aged, MESH: Intraoperative Period, MESH: Humans, business.industry, Brain shift, Mr angiography, Magnetic resonance imaging, Ultrasonography, Doppler, MESH: Adult, MESH: Neurosurgical Procedures, MESH: Male, MESH: Phantoms, Imaging, MESH: Ultrasonography, Doppler, Surgery, Artificial intelligence, Doppler ultrasound, business, MESH: Female, Magnetic Resonance Angiography
Abstract

International audience; PURPOSE: We describe and validate a novel hybrid nonlinear vessel registration algorithm for intra-operative updating of preoperative magnetic resonance (MR) images using Doppler ultrasound (US) images acquired on the dura for the correction of brain-shift and registration inaccuracies. We also introduce an US vessel appearance simulator that generates vessel images similar in appearance to that acquired with US from MR angiography data. METHODS: Our registration uses the minimum amount of preprocessing to extract vessels from the raw volumetric images. This prevents the removal of important registration information and minimizes the introduction of artifacts that may affect robustness, while reducing the amount of extraneous information in the image to be processed, thus improving the convergence speed of the algorithm. We then completed 3 rounds of validation for our vessel registration method for robustness and accuracy using (i) a large number of synthetic trials generated with our US vessel simulator, (ii) US images acquired from a real physical phantom made from polyvinyl alcohol cryogel, and (iii) real clinical data gathered intra-operatively from 3 patients. RESULTS: Resulting target registration errors (TRE) of less than 2.5 mm are achieved in more than 90 % of the synthetic trials when the initial TREs are less than 20 mm. TREs of less than 2 mm were achieved when the technique was applied to the physical phantom, and TREs of less than 3 mm were achieved on clinical data. CONCLUSIONS: These test trials show that the proposed algorithm is not only accurate but also highly robust to noise and missing vessel segments when working with US images acquired in a wide range of real-world conditions.

Published
2012

13. Hierarchical multimodal image registration based on adaptive local mutual information

Author

Dante, De Nigris, Laurence, Mercier, Rolando, Del Maestro, D Louis, Collins, and Tal, Arbel

Subjects
Subtraction Technique, Image Interpretation, Computer-Assisted, Brain, Humans, Reproducibility of Results, Image Enhancement, Echoencephalography, Magnetic Resonance Imaging, Sensitivity and Specificity, Algorithms, Pattern Recognition, Automated
Abstract

We propose a new, adaptive local measure based on gradient orientation similarity for the purposes of multimodal image registration. We embed this metric into a hierarchical registration framework, where we show that registration robustness and accuracy can be improved by adapting both the similarity metric and the pixel selection strategy to the Gaussian blurring scale and to the modalities being registered. A computationally efficient estimation of gradient orientations is proposed based on patch-wise rigidity. We have applied our method to both rigid and non-rigid multimodal registration tasks with different modalities. Our approach outperforms mutual information (MI) and previously proposed local approximations of MI for multimodal (e.g. CT/MRI) brain image registration tasks. Furthermore, it shows significant improvements in terms of mTRE over standard methods in the highly challenging clinical context of registering pre-operative brain MRI to intra-operative US images.

Published
2010

15. Spheroid Preparation from Hanging Drops: Characterization of a Model of Brain Tumor Invasion.

Author

Danny Del Duca, Tamra Werbowetski, and Rolando Del Maestro

Abstract

Background: The use of three-dimensional in vitro models of brain tumor invasion has provided a system for reconstructing some of the cellular microenvironments present in the tumor mass. While spheroids of murine and human astrocytoma cells can be prepared using spinning cultures, spheroid preparation using many cell lines is not amenable to this method. We have developed a reproducible system of creating implantable spheroids that is applicable to different cell lines, and is independent of cell line characteristics. [ABSTRACT FROM AUTHOR]

Published
2004

18. Intradural spinal hematoma in an infant with cystic fibrosis

Author

Edward Ecclestone, George G. Hinton, Douglas W. Zochodne, Rolando Del Maestro, and Robert Coates

Subjects
Male, medicine.medical_specialty, Cord, Spinal hematoma, Cystic Fibrosis, Chest physiotherapy, Cystic fibrosis, Hematoma, Developmental Neuroscience, Spinal cord compression, Coagulopathy, medicine, Humans, Myelography, business.industry, Infant, Subarachnoid Hemorrhage, medicine.disease, Surgery, Hematoma, Subdural, Neurology, Pediatrics, Perinatology and Child Health, Subdural bleeding, Neurology (clinical), business, Spinal Cord Compression
Abstract

An 8-month-old male infant with cystic fibrosis developed quadriplegia secondary to spinal cord compression. Surgery revealed an extensive intradural hematoma from C3 to T9. An underlying structural source of bleeding was not identified and the patient did not have a coagulopathy. Repeated chest physiotherapy was the only known trauma that the infant had sustained. Spinal subarachnoid and subdural bleeding is a rare form of cord compression that apparently has not been described previously in association with cystic fibrosis. The current vigorous physiotherapeutic approach to cystic fibrosis necessitates awareness of the possible complications of this therapy.

Published
1986

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