Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Anatomy and Cell Biology


de Ribaupierre, Sandrine

2nd Supervisor

Eagleson, Roy



As medical education and specialty training continues to move in the direction of competency-based training, assisted with the progression of simulation-based modules, the importance of establishing objective assessment parameters and performance metrics is becoming more clear. Currently, interventionalist training focusing on endovascular skills in cerebral angiography (an imaging procedure used to diagnose and treat stroke and vascular disorders), continues to rely on quantity of clinical experience rather than its quality, and has lagged in developing objective performance markers. Immersive, realistic, and haptically-accurate simulators have been developed in this field for the purposes of training future expert interventionalists, however, their utility has been washed out due to a poor understanding of transferrable clinical skills and performance markers to be used in medical fellowship programs.

This dissertation assessed the perceived competencies and operational obstacles observed by neurointerventionalists to inform an assessment of diagnostic and interventional skills which can be developed in simulation-based training. Inquiry into clinically significant steps in cerebral angiography revealed a relationship between clinical procedural tasks which were rated to be highly important and risky, such as those associated with vascular navigation and aneurysm coiling. The results of our studies suggest that navigational skills in simulation-based diagnostic angiography training could be improved with independent practice. Furthermore, navigational competency was strongly linked to mental rotation ability, the lack of which could be supplemented with visual assistance overlay tools. Most importantly, the data suggests that independent training of neurointerventional skills, such as aneurysm coiling, in simulation-based training may be an effective method of complementary training with minimal resources, as improvement in aneurysm coiling quality and pace was observed in simulation.

Using objective assessments of targeted skillsets in simulation-based training can alleviate the training burden in neurointerventional radiology and provide performance metrics to improve training standards while minimizing resource waste, including both attending clinician resources and operating room use for training.

Summary for Lay Audience

Brain aneurysms are a common condition that affects people of all ages and often go undetected until medical intervention is needed. In Canada, approximately 3.2% of the population, or 1.1 million people, live with unruptured brain aneurysms. These aneurysms are often discovered during MRI scans, which occur in almost 2% of all cases. As a result, there is a large population of patients with aneurysms who require medical diagnosis and intervention.

The standard treatment for brain aneurysms is angiography, which uses minimally invasive catheters to navigate the body's blood vessels and locate and treat areas of weakness. These procedures allow patients to be treated and released the same day, but they require interventional specialists with extensive training in order to perform them safely and effectively. Neurointerventionalists can access the blood vessels through the patient's leg, but they must be able to spatially navigate through the lumen, use x-ray imaging to understand their catheter position within the body, and pack an aneurysm in the brain with electrolytic coils carefully controlled at the access site around the patient's thigh.

This complex array of skills is currently only formally learned through operating room-based fellowship programs, which result in high healthcare costs and inefficient skill development opportunities for novice fellows. This thesis has focused on measuring our ability to use simulation in cerebral angiography training by assessing the factors that affect performance and the parts of the procedure best trained using simulation. The research has suggested that moving tools through the arteries and treating the aneurysm are some of the most important steps, and practicing them in simulation on their own helps novices improve and avoid making mistakes critical mistakes. These promising results clarify the skills we need to target to accelerate the inclusion of simulation in training in this field.

Available for download on Wednesday, June 19, 2024