Objective Assessment of Colonoscope

11 Objective: Manipulation of the colonoscope is a technical challenge for novice clinicians which is 12 best learned in a simulated environment. It involves the coordination of scope tip steering with 13 scope insertion, using a rotated image as reference. The purpose of this work is to develop and 14 validate a system which objectively assesses colonoscopy technical skills proficiency in an arbitrary 15 training environment, allowing novices to assess their technical proficiency prior to real patient 16 encounters. 17 Methods: We implemented a motion tracking setup to objectively analyze and assess the way 18 operators perform colonoscopies, including an analysis of wrist and elbow joint motions. 19 Subsequently, we conducted a validation study to verify whether our motion analysis could 20 discriminate novice colonoscopists from experts. Participants navigated a wooden bench-top 21 model using a standard colonoscope while their motions were tracked. 22 Results: The developed motion tracking setup allowed colonoscopists of varying levels of 23 proficiency to have their colonoscope manipulation assessed, and was able to be operated by a 24 trained non-technical operator. Novice operators had significantly greater median times (101.5s 25 vs. 31.5s) and number of hand movements (62.0 vs. 21.5) than experts. Experts, however, spent a 26 significantly greater proportion of time in extreme ranges of wrist and elbow joint motion than 27 novices. 28 Conclusion: We have developed and implemented a hand and joint motion analysis system that is 29 able to discriminate novices from experts based on objective measures of motion. These metrics 30 could, thus, serve as proxies for technical proficiency during training. 31 32