Objective: Technical skill assessment plays an important
role in the professional development of an interventionalist
in percutaneous coronary intervention (PCI), however, most of
traditional assessment methods are time-consuming and subjective.
This paper aims to develop objective assessment techniques.
Methods: In this study, a natural-behavior-based assessment
framework is proposed to qualitatively and quantitatively assess
technical skills in PCI. In vivo porcine studies were conducted
to deliver a medical guidewire to two target coronaries of left
circumflex arteries by six novice and four expert interventionalists.
Simultaneously, four types of natural behaviors (i.e.,
hand motion, proximal force, muscle activity and finger motion)
were acquired from the subjects’ dominant hand and arm. The
features extracted from behaviors of different skill-level groups
were compared using Mann-Whitney U-test for effective behavior
selection. The effective ones were further applied in Gaussianmixture-
model-based qualitative assessment and Mahalanobisdistance-
based quantitative assessment. Results: The qualitative
assessment achieves an accuracy of 92 to distinguish the novice
and expert attempts, which is significantly higher than that of
using single guidewire motions. Furthermore, the quantitative
assessment can assign objective and effective scores for all attempts,
indicating high correlation (R=0.9225) to those obtained
by traditional methods. Conclusion: The objective, effective and
comprehensive assessment of technical skills can be provided
by qualitatively and quantitatively analyzing interventionalists’
natural behaviors in PCI. Significance: This paper suggests a
novel approach for technical skill assessment and the promising
results demonstrate the great importance and effectiveness of
the proposed method for promoting the development of objective
assessment techniques.