• Elio Beta, Ashesh S Parikh, Mandie Street, and James R Duncan.
• Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA.
• J Vasc Interv Radiol. 2009 Jun 1; 20 (6): 769-81.

PurposeImprovement of performance during image-guided procedures begins with close observation of existing systems. Recording of procedures and detailed analysis of those recordings may provide considerable insight into how performance might be improved.Materials And MethodsMultiple video and audio recording devices were used to capture the stimulus/response cycles that occur during uterine artery embolization, transjugular intrahepatic portosystemic shunt creation, and Port-a-Cath placement. These records were compiled, and data regarding radiation use were extracted from each procedure. Recordings from Port-a-Cath placement were also used to assess operator performance during ultrasound (US)-guided venous access and medication handling.ResultsThe recordings were used to assess how physicians use visual and auditory information to drive decisions during image-guided procedures. Correlating radiation dose with the modality used to acquire the image and the procedure timeline produced a series of clear patterns. Fluoroscopy was used to guide decisions during the vast majority of each procedure. Acquisition of digital subtraction angiographic images caused a substantial increase in radiation flux. There were clear instances in which the additional information provided by the increased dose was considered essential to the decision-making process, but there were also instances in which it appeared that the additional information did not drive intraprocedural decisions. Analysis of a US-guided procedure demonstrated that the physician would not advance the needle whenever its position relative to the target was uncertain.ConclusionsAnalysis of these detailed recordings provided important insights into how visual information is used during image-guided procedures. The results suggest there would be considerable benefit to matching information-gathering activities to the operators' capacity to analyze information and make decisions.

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