Feasibility and non-inferiority of mobile telementoring for digital subtraction angiography: a single-center observational study
Clinical Snapshot
PICO Framework
| P — Population | 71 patients undergoing digital subtraction angiography at a single neurosurgical center |
| I — Intervention | Mobile telementoring system (JOIN platform) for real-time remote supervision |
| C — Comparator | Traditional face-to-face mentoring during DSA procedures |
| O — Outcomes | Contrast volume, procedural time, radiation dose, procedural complications, user satisfaction |
Bottom Line
This single-center study suggests mobile telementoring for DSA procedures is feasible and non-inferior to traditional face-to-face supervision across key procedural metrics. While promising for addressing specialist shortages in remote areas, the evidence is limited by small sample size, single-center design, and unclear allocation methods. The technology could enhance access to expert guidance in Australian rural hospitals, but implementation would require careful consideration of internet infrastructure, regulatory approval, and integration with existing telehealth services. Larger multi-center studies with randomized allocation are needed to confirm these preliminary findings before widespread adoption.
Key Findings
P Value: p=0.499 (contrast), p=0.308 (time), p=0.346 (radiation)
Effect Size: Contrast volume difference: 8.8 mL (88.3 vs 97.1 mL); Procedural time difference: 6.6 min (44.1 vs 50.7 min); Radiation dose difference: 78.7 mGy (427.9 vs 506.6 mGy)
Primary Outcome: Non-inferiority demonstrated for all three primary endpoints
Nnt Or Sensitivity: Non-inferiority margin of 20% achieved for all primary endpoints
Confidence Interval: Not reported
Clinical Application
Requires reliable internet connectivity, mobile platform technology, and trained remote supervisors Relevant for rural and remote Australian hospitals; would require TGA approval for medical device software and integration with existing telehealth frameworks under Medicare Benefits Schedule Patients requiring DSA in centers with limited on-site specialist supervision
Abstract
BACKGROUND: Telementoring is an emerging approach in surgical education that offers remote supervision and guidance through digital platforms. This study aimed to evaluate the feasibility and non-inferiority of a mobile-based telementoring system for digital subtraction angiography (DSA) and compare it with traditional face-to-face mentoring. METHODS: This prospective, single-center observational study included 71 patients who underwent DSA between April 2021 and May 2024. Patients were categorized into control (n=48, face-to-face mentoring) and telementoring (n=23) groups. A mobile telementoring system (JOIN, Allm Inc., Tokyo, Japan), which enabled real-time image sharing and voice communication between the examiner and the remote supervisor, was employed. The primary endpoints were contrast volume, procedural time, and radiation dose, with a non-inferiority margin of 20% applied. RESULTS: No significant differences were observed between the two groups in contrast volume (88.3±39.6 mL vs 97.1±36.4 mL, p=0.499), procedural time (44.1±17.7 min vs 50.7±19.0 min, p=0.308), or radiation dose (427.9±262.2 mGy vs 506.6±307.1 mGy, p=0.346). Non-inferiority was confirmed across all primary endpoints. No procedural complications occurred. Qualitative feedback indicated high user satisfaction, with the system facilitating effective remote supervision and decision-making. CONCLUSIONS: This study demonstrates the feasibility and non-inferiority of a mobile telementoring system for DSA, effectively supporting real-time remote guidance and reducing the need for on-site supervision. Its implementation may enhance access to expert mentoring, particularly in regions with limited specialist availability, contributing to equitable and efficient cerebrovascular care.
References
- 1.Osanai, T., Uchino, H., Tokairin, K., Kurisu, K., & Fujimura, M. (2026). Feasibility and non-inferiority of mobile telementoring for digital subtraction angiography: a single-center observational study. Journal of Neurointerventional Surgery. https://doi.org/10.1136/jnis-2025-023676
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