An Equitable Electronic Scheduling System for Anesthesiology Residents: A Quality Improvement Project.

BACKGROUND: Most postgraduate medical education occurs in hospitals in an apprenticeship model with actual patients. Creating a work shift schedule must account for complex factors, including hospital needs, work-hour restrictions, trainee qualifications, and case distribution in order to fairly allocate the resident workload. In this study, we report the first successful implementation of an equitable, computer-generated scheduling system for anesthesiology residents. METHODS: A total of 24 residents at a single, urban training program were surveyed in 2015 to rank work shift difficulty. Shifts were categorized and translated into a weighted point system by program leadership based on the survey results. An automated and modifiable scheduling system was created to incorporate rule-based assignment of prerequisites and evenly distribute points throughout the academic year. Point values were retrospectively calculated in 2014, and prospectively calculated from 2015 to 2018. The equality of variance test was used to evaluate the variation of the SD of monthly average point distributions year-over-year and within each class of trainees. RESULTS: Year-over-year analysis revealed that post-point system implementation, call point distribution trended toward reduced variance in all 4 years, with significant reductions of 63% in 2016 (SD 4.9, P < .01), and 57% in 2017 (SD 5.8, P < .01). Analyzed by class, first-year trainees' SD decreased by 73% in 2016 (SD 2.5, P < .01), by 67% in 2017 (SD 3.1, P < .04), and 65% in 2018 (SD 3.3, P < .02) compared with the pre-point system year in 2014. The second year clinical anesthesia resident class SD decreased by 56% in 2015 (SD 5.9, P < .01), 41% in 2016 (SD 7.9, P < .02), and 49% in 2017 (SD 6.9, P < .01). CONCLUSION: The computerized point system improved work distribution equity year-over-year and within trainee cohort groups.

Treatment planning and image guidance for radiofrequency ablation of large tumors.

This article addresses the two key challenges in computer-assisted percutaneous tumor ablation: planning multiple overlapping ablations for large tumors while avoiding critical structures, and executing the prescribed plan. Toward semiautomatic treatment planning for image-guided surgical interventions, we develop a systematic approach to the needle-based ablation placement task, ranging from preoperative planning algorithms to an intraoperative execution platform. The planning system incorporates clinical constraints on ablations and trajectories using a multiple objective optimization formulation, which consists of optimal path selection and ablation coverage optimization based on integer programming. The system implementation is presented and validated in both phantom and animal studies. The presented system can potentially be further extended for other ablation techniques such as cryotherapy.

Needle-based interventions with the image-guided surgery toolkit (IGSTK): from phantoms to clinical trials.

We present three image-guided navigation systems developed for needle-based interventional radiology procedures, using the open source image-guided surgery toolkit (IGSTK). The clinical procedures we address are vertebroplasty, RF ablation of large lung tumors, and lung biopsy. In vertebroplasty, our system replaces the use of fluoroscopy, reducing radiation exposure to patient and physician. We evaluate this system using a custom phantom and compare the results obtained by a medical student, an interventional radiology fellow, and an attending physician. In RF ablation of large lung tumors, our system provides an automated interventional plan that minimizes damage to healthy tissue and avoids critical structures, in addition to accurate guidance of multiple electrode insertions. We evaluate the system's performance using an animal model. Finally, in the lung biopsy procedure, our system replaces the use of computed tomographic (CT) fluoroscopy, reducing radiation exposure to patient and physician, while at the same time enabling oblique trajectories which are considered challenging under CT fluoroscopy. This system is currently being used in an ongoing clinical trial at Georgetown University Hospital and was used in three cases.

Radiofrequency ablation of lung tumors in swine assisted by a navigation device with preprocedural volumetric planning.

PURPOSE: To develop an image guidance system that incorporates volumetric planning of spherical ablations and electromagnetic tracking of radiofrequency (RF) electrodes during insertion. MATERIALS AND METHODS: Simulated tumors were created in three live swine by percutaneously injecting agar nodules into the lung. A treatment plan was devised for each tumor with optimization software to solve the planning problem. The desired output was the minimum number of overlapping ablation spheres necessary to ablate each tumor and the margin. The insertion plan was executed with use of the electromagnetic tracking system that guided the insertion of the probe into precomputed locations. After a 72-hour survival period, animals were killed and histopathologic sections of the tissue were examined for cell viability and burn pattern analysis. RESULTS: A planning algorithm to spherically cover the tumors and the margin was computed. Electromagnetic tracking allowed successful insertion of the instrument, and impedance roll-off was reached in all ablations. Depending on their size, the tumors and the tumor margins were successfully covered with two to four ablation spheres. The image registration error was 1.0 mm +/- 0.64. The overall error of probe insertion was 9.4 mm +/- 3.0 (N = 8). Analysis of histopathologic sections confirmed successful ablations of the tissue. CONCLUSIONS: Computer-assisted RF ablation planning and electromagnetically tracked probe insertion were successful in three swine, validating the feasibility of electromagnetic tracking-assisted tumor targeting. Image misregistration caused by respiratory motion and tissue deformation contributed to the overall error of probe insertion.