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International teleproctoring in neurointerventional surgery and its potential impact on clinical trials in the era of COVID-19: legal and technical considerations.
Orru', Emanuele; Marosfoi, Miklos; Patel, Neil V; Coon, Alexander L; Wald, Christoph; Repucci, Nicholas; Nicholson, Patrick; Pereira, Vitor M; Wakhloo, Ajay K.
  • Orru' E; Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA surgeon.ema@gmail.com.
  • Marosfoi M; Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
  • Patel NV; Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
  • Coon AL; Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA.
  • Wald C; Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
  • Repucci N; Research Administration, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
  • Nicholson P; Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Pereira VM; Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.
  • Wakhloo AK; Neurointerventional Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
J Neurointerv Surg ; 13(11): 1022-1026, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-991864
ABSTRACT

BACKGROUND:

Existing travel restrictions limit the mobility of proctors, significantly delaying clinical trials and the introduction of new neurointerventional devices. We aim to describe in detail technical and legal considerations regarding international teleproctoring, a tool that could waive the need for in-person supervision during procedures.

METHODS:

International teleproctoring was chosen to provide remote supervision during the first three intracranial aneurysm treatments with a new flow diverter (currently subject of a clinical trial) in the US. Real-time, high-resolution transmission software streamed audiovisual data to a proctor located in Canada. The software allowed the transmission of images in a de-identified, HIPAA-compliant manner.

RESULTS:

All three flow diverters were implanted as desired by operator and proctor and without complication. The proctor could swap between images from multiple sources and reported complete spatial and situational awareness, without any significant lag or delay in communication. Procedural times and radiologic dose were similar to those of uncomplicated, routine flow diversion cases at our institution.

CONCLUSIONS:

International teleproctoring was successfully implemented in our clinical practice. Its first use provided important insights for establishing this tool in our field. With no clear horizon for lifting the current travel restrictions, teleproctoring has the potential to remove the need for proctor presence in the angiography suite, thereby allowing the field to advance through the continuation of trials and the introduction of new devices in clinical practice. In order for this tool to be used safely and effectively, highly reliable connection and high-resolution equipment is necessary, and multiple legal nuances have to be considered.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Intracranial Aneurysm / Endovascular Procedures / COVID-19 Type of study: Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: J Neurointerv Surg Year: 2021 Document Type: Article Affiliation country: Neurintsurg-2020-017053

Full text: Available Collection: International databases Database: MEDLINE Main subject: Intracranial Aneurysm / Endovascular Procedures / COVID-19 Type of study: Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: J Neurointerv Surg Year: 2021 Document Type: Article Affiliation country: Neurintsurg-2020-017053