Virtual reality, ultrasound-guided liver biopsy simulator: Development and performance discrimination

Objectives: The aim of this article was to identify and prospectively investigate simulated ultrasound-guided targeted liver biopsy performance metrics as differentiators between levels of expertise in interventional radiology.Methods: Task analysis produced detailed procedural step documentation allowing identification of critical procedure steps and performance metrics for use in a virtual reality ultrasound-guided targeted liver biopsy procedure. Consultant (n=14; male=11, female=3) and trainee (n=26; male=19, female=7) scores on the performance metricswere compared. Ethical approval was granted by the Liverpool Research Ethics Committee (UK). Independent t-tests and analysis of variance (ANOVA) investigated differences between groups.Results: Independent t-tests revealed significant differences between trainees and consultants on three performance metrics: targeting, p=0.018, t=22.487 (22.040 to20.207); probe usage time, p=0.040, t=2.132 (11.064 to 427.983); mean needle length in beam, p=0.029, t=22.272 (20.028 to 20.002). ANOVA reported significant differences across years of experience (0–1, 1–2, 3+ years) on seven performance metrics: no-go area touched, p=0.012; targeting, p=0.025; length of session, p=0.024; probe usage time, p=0.025; total needle distance moved, p=0.038; number of skin contacts, p<0.001; total time in no-go area, p=0.008. More experienced participants consistently received better performance scores on all 19 performance metrics.Conclusion: It is possible to measure and monitor performance using simulation, with performance metrics providing feedback on skill level and differentiating levels of expertise. However, a transfer of training study is required

The northern hemisphere circumglobal teleconnection in a seasonal forecast model and its relationship to European summer forecast skill

Forecasting seasonal variations in European summer weather represents a considerable challenge. Here, we assess the performance of a seasonal forecasting model at representing a major mode of northern hemisphere summer climate variability, the circumglobal teleconnection (CGT), and the implications of errors in its representation on seasonal forecasts for the European summer (June, July, August). Using seasonal hindcasts initialised at the start of May, we find that the model skill for forecasting the interannual variability of 500 hPa geopotential height is poor, particularly over Europe and several other “centres of action” of the CGT. The model also has a weaker CGT pattern than is observed, particularly in August, when the observed CGT wavetrain is strongest. We investigate several potential causes of this poor skill. First, model variance in geopotential height in west-central Asia (an important region for the maintenance of the CGT) is lower than observed in July and August, associated with a poor representation of the link between this region and Indian monsoon precipitation. Second, analysis of the Rossby wave source shows that the source associated with monsoon heating is both too strong and displaced to the northeast in the model. This is related to errors in monsoon precipitation over the Bay of Bengal and Arabian Sea, where the model has more precipitation than is observed. Third, the model jet is systematically shifted northwards by several degrees latitude over large parts of the northern hemisphere, which may affect the propagation characteristics of Rossby waves in the model