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An INR’s Perspective on the Future of Interventional Procedures

As interventional procedures become more complex and time-demanding, there is a greater need for physicians to meet increasing procedural challenges..

September 15, 2021
Stacy Hammar, et al

As interventional procedures become more complex and time-demanding, there is a greater need for physicians to meet increasing procedural challenges with realistic and immersive training solutions. When physicians are able to improve the standards of their procedural workflow proficiency, they unlock new techniques that exponentially boost confidence for health care professionals and positive outcomes for patients and Health care providers. 


Ultimately, these solutions save time on critical life-saving procedures and cut back dramatically on long-term learning and operating costs, all the while bringing a new gold standard to continuous best practice. In this blog, we dive into the virtual patient simulation experiences of dedicated physician and long-time Mentice user Dr. Kornelia Kreiser, Head of Neuroradiology at University Hospital Ulm, Germany. 


As a major proponent for realistic simulation, Dr. Kreiser has experienced all generations of the VIST Virtual patient, from VIST-C, the first portable endovascular simulator, to VIST G5, and through to the current VIST G7- a fully immersive platform with the most advanced technology on the market. We had the opportunity to ask her a few questions about her experiences over the years, and her take on the future of simulation in moving toward vast educational and cost improvements for healthcare systems globally.


Explore the key takeaways of the blog:

1. The evolution of the VIST solutions:
From Technical Skills and Device Manipulation to a Fully Immersive Platform
How the adoption and evolution of VIST solutions have brought about vast improvements to patient outcomes and hospital costs, with quality training curriculums that optimize healthcare workflows and patient safety.

2. The Benefits of Linking Simulation to the Angiography Suite:
Including the ability to import patient-specific data
Beyond procedural & device learning, learn how the extended platform integration allows for pivotal angiography suite training to further benefit both trainees and experienced interventionalists.

3. How virtual patient simulation combined with a structured curriculum can scale up your INR department  
Delve into the specific INR peer and departmental challenges, how such a capital investment was leveraged, the immediate goal for utilization, and why the choice fell on Mentice solutions.

4. The future of simulation:
mpacting procedural standardization and enabling remote training
Virtual patient simulation as a new consensus - the optimal solution for exposure, independent training, remote learning, and a refresher for interventional teams to optimize, realign and regain their subconscious team dynamics.



The Evolution to Fully Immersive Training Solutions: From Technical Skills & Device Manipulation to a Fully Immersive Platform


Over the last decade, Dr. Kreiser has brought about vast improvements to patient outcomes and hospital costs with quality training curriculums supported by VIST solutions. Starting in Munich with VIST-C, Dr. Kreiser has created complex neurovascular thrombectomy and aneurysm training scenarios and moved on to publish insightful and ground-breaking papers on simulation training covering research topics in neuro angiography and patient-specific rehearsal. Now, as the new head of department in Ulm, she has created and currently leads her own assessment-based curriculum with VIST G7 and plans to implement the Virtual Patient Link (full integration into the Angio-Suite controls), an extended platform allowing for pivotal cath lab training that she heavily utilized in her previous position in Technical University Munich. Let’s take a closer look at her experiences in her own words.




What is the most significant benefit derived from fully immersive training solutions?

"It has become unnecessary to practice procedures on living patients, where there is a high risk for patients and more stress for interventionalists and their teams. With a virtual patient simulator, you have the advantage of replicating and performing procedures with more confidence and no added risk to patient and staff safety, ensuring a more significant reduction in procedure times, fluoroscopy times, and less contrast used, improving patient outcomes. These skills (gained or refreshed) can be transferred when it is time for the real patient."

To start, Dr. Kreiser points that the most significant benefit from her reliance on simulation-centered curriculums is the improved patient experience. The opportunity to save time and cut down on costs while improving the quality of education for healthcare professionals is what will ultimately optimize patient safety, interventional education, and a much-improved hospital workflow. Since the VIST-C, Dr. Kreiser has experienced these benefits, with each upgrade providing improved realism within device behavior and haptic feedback, complex scenarios, and usability.


How has each upgrade of VIST over the last decade impacted simulation experiences for your research, training, and curriculums?

"The leap in technological advances has enabled beginners to learn the basic skills required to perform their first angiography and to get a perfect start to the field of complex interventional procedures. Importing actual patient cases creates access to an unlimited number of training opportunities, individual preparation, and repetition of complex cases. The evolution in the degree of detail and realism of anatomies and catheter performance has allowed learning on specific techniques and maneuvers. There are also exercises where you are guided through all the necessary steps of the case; you are stimulated to think about pre-interventional imaging and possible pitfalls, such as catheter-related spasms." 

What started as a primary training solution has now become a fully immersive curriculum. For Dr. Kreiser, these advancements have opened new possibilities in complex interventional procedures. Through each upgrade, Dr. Kreiser has witnessed added flexibility, saved time, and improved educational opportunity to her training sessions. The entire team has been able to delve into training not only for the basics but also for even more complex insights on specific procedural techniques through each upgrade of VIST.

How have the technical improvements of VIST further added value to the learning workflow?

"With all these improvements, there has been a tremendous effort to make the system more user-friendly and reliable – eliminating technical issues and removing the need to calibrate or clean. Previously, you had to practice every case right from the start, but now you can also practice the individual parts of treatment. This combination allows me to manage highly efficient training sessions for many hours without disruption."

As Dr. Kreiser has created comprehensive curriculums around Mentice solutions, she has also been a key supporter of its technical improvements over the years. Like many other healthcare professionals using this technology, Dr. Kreiser has been a major soundboard for optimizing the VIST as we see it today; a highly robust and user-friendly solution. Now, Dr. Kreiser manages and implements insightful training sessions, saving healthcare professionals valuable time and all without disruption. By upgrading VIST around user needs, more research and learning applications are enabled with higher capability to individualize training of specific treatment components. In turn, allowing the trainees to invest dedicated quality time learning without added risk or stress.




The Benefits of Linking Simulation to the Angiography Suite
Beyond procedural & device learning, how do you integrate simulation with the angiography suite to further enhance the experience utilizing the Mentice Virtual Patient Link (VPL)?

"The ability to link the virtual patient into the angiography suite has led to a significant milestone in simulation training in my curriculum. In tutoring beginners,

the degree of reality has increased enormously. Working with biplane angiography, in particular, it involves operating multiple buttons and foot pedals that it may distract from the actual catheter handling. Even experienced interventionalists, such as I, can benefit from the integration when being introduced or becoming accustomed to new angiography suites. In my department, we have angiography suites from different vendors, and simulation offers an excellent opportunity to stay ‘fit’ on both imaging systems." 


When it comes to integration with the angiography suite, fully immersive learning is able to come to a full circle. Dr. Kreiser utilizes the VPL to educate and train operators, especially as the hospital upgrades to new C-arms or more complex biplane angiography. By providing focused C-arm training, resulting in less distraction from learning on the actual procedure at hand, and in turn, it reduces learning by trial on real patients, eradicating unnecessary radiation exposure and device utilization.

Click to play the full video



It takes time getting familiar with a new C-arm, which usually requires an education specialist to provide support during real patient procedures. By learning the control panel and diagnostic software ahead of time, away from real patients, we improve not only the safety of patients but also allow operators to learn independently without as much need for specialists.


How do you think the combination of simulation and the ability to import real patient CT/MRI/ 3D data could add to the overall patient experience?


"Within my research, practicing patient-specific data sets in advance has not yet turned out to be a measurable advantage in the context of a study, which could be proven based on a reduced number of complications. However, this possibility is still extremely valuable for planning and is being further researched. Suppose a patient's anatomy deviates significantly from the 'normal'; it can ultimately save a lot of time if you can deal with it in detail and test different catheter configurations."


With VIST, it is possible to simulate a variety of complex cases within an advanced learning environment that allows for multiple runs, various manipulations, and extended capabilities during the learning experience. While more research is underway, Dr. Kreiser has previously proven trainees who have trained on VIST simulators perform better, in less time, and with less radiation used than those who have not been subjected to simulation training.  


Kreiser, et al, proved that a structured simulation-based curriculum to teach angiographic skills resulted in a reduction of fluoroscopy time and radiation dose in the first real angiographies of novice angiographers.
Click here to read the full study

In another study, Dr. Kreiser, et al, investigated the training effectiveness of simulators and proved the validity of this method for novices -
In a comparison of the first five simulated cases with the last five simulated cases, participants improved significantly in terms of total duration, fluoroscopy time, and perceived effort (total duration 31.94min to 21.15; fluoroscopy time 18.15min to 13.42min.
Click to see the full paper

How virtual patient simulation combined with a structured curriculum can scale up your INR department

As Head of Neuroradiology at University Hospital Ulm, why did you ultimately choose Mentice for your simulation solutions?

"Ulm would like to significantly expand the neuro-interventional division and does not currently employ any experts in this field. One reason why I was requested for this position is my affinity for teaching and training. Due to the lack of experienced neuro-interventionalists on the labor market, clinics must train these largely themselves. I have therefore linked the purchase of a simulator to my acceptance for the post. The choice fell on Mentice not only because I have many years of true value experience with their simulators but because the connection with a real angiography is mandatory for my decision and is currently not offered by any other manufacturer."


Previously at TUM and now at Ulm University Hospital, it is mandatory that operators must learn on virtual patient simulators before approaching real procedures. Each operator must perform a minimum of 20 cerebral angiographies on the simulator. These procedures are performed independently with recorded progress metrics, but after every 5th procedure, a supervised case is performed to access the progress, with the necessary corrective guidance. The number of required procedures can vary for each operator. However, even after completing the first real angiography, it proved helpful to return to the simulator again and again. As such, Dr. Kreiser believes that simulation is not a choice as head of any department but more so a necessary principle to uphold for all interventionalists in training and onboarding. With such solutions so well-integrated into her curriculum, Dr. Kreiser feels confident relying on VIST, the only immersive solution available in the market.


What are your current goals with our solutions at University Hospital Ulm?


"I currently employ two experienced residents, whom I want to instruct on thrombectomy as soon as possible so that they can support the team in the on-call service. Both have only had peripheral angiography experience so far. A targeted practice of diagnostic supra-aortic anatomies and the detailed accompaniment of simulated thrombectomies should allow for repeated simulation until they can carry out an entire procedure independently."


Educational opportunities are limitless with VIST solutions. Dr. Kreiser is able to instruct operators on specific cases and optimize the team’s performance for better outcomes. It unlocks more insight for learners who may have not yet had the experience of real procedures or certain pathologies or clinical devices in specific areas, allowing them to repeat the simulation until they feel entirely comfortable with every step of the procedure and within the immersive clinical setting.


The Future of Simulation

Do you believe simulation will significantly impact procedural standardization in Germany as a form of reliable quality assurance? How can this be achieved?


"I am convinced that simulation will be essential as part of the certification and required for courses in Germany. I am an advocate that a consensus can be determined within the next 1-2 years as to which skills should be taught or assessed using simulation."


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