Improving patient

We went into the operating theatre with Cydar to help enhance their visualisation system for endovascular surgery.

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Design in an extraordinary context


Cydar are a leading provider of cloud-based services that fuse images of patient data with live X-ray images to provide real-time 3D visualisations of endovascular systems. Using their services reduces radiation risks and exposure to chemicals for patients, enhances surgical workflow and dramatically improves patient outcomes.

However, Cydar knew from their customers that the system used in operating theatres needed significant usability and user experience improvements, and so they asked Foolproof to work with them to understand the opportunities.

Through observation and interviews with surgeons, radiographers, and support staff we used principles of user-centred design to design, test, and iterate improvements to the interface and visualisation system - in the extraordinary context of the operating theatre.

This environment required us to learn a whole new vocabulary to enable us to work closely with surgical practitioners. This involved being in the operating theatre to see for ourselves how practitioners interacted during surgery.

Gathering critical insight

An initial stakeholder workshop at Cydar’s Cambridgeshire base enabled us to understand the business vision and agree on a shared view of the opportunities for the enhanced experience. It was also our introduction to the unique complexity of the system and user’s context.

A series of interviews with surgeons already using the system in two UK hospitals, helped us to evaluate their current experience and gather critical insights. Quickly, it became clear that the surgical users had a very low tolerance for unnecessary ‘clutter’ and non-critical functionality, and clear opinions on what they needed from the system to help them make better decisions.

In these interviews and in subsequent testing it was very important that we spoke using the language of their practice. While a steep learning curve for our researchers and designers, it established a level of trust that was invaluable and facilitated a much deeper level of understanding.

Low-fi Interface sketches

Context driven design

Interface mock ups with a paper prototype background

The most revealing research was conducted during live surgery, to understand how surgeons interacted with the system during an operation. The learnings from surgery revealed fundamental environmental and behavioural insights that had significant impact on the design that could simply not be evaluated through interview alone.

Taking the insights from research, we sketched initial concepts for interface components and screens which we tested with surgeons, and then evolved into high-fidelity screens and a prototype. In testing the prototype, we discovered that the smallest elements of the interface had the biggest impact and provided most value to the surgeons, which forced us to focus on micro-interactions that we may have completely overlooked.

At its core the project was all about applying solid experience design method in extraordinary new environments, with a whole new vocabulary, while relentlessly focusing on surgical outcomes. Or, as Tom Carrell co-founder of Cydar commented, ‘ultimately, it is all about improving the patient experience’.

UI displaying elements of a patients endovascular system

Widespread clinical adoption

Tom Carrell, CEO, Cydar, “We were wonderfully impressed with the Foolproof team’s ability to extract insights from very disparate and difficult user groups, and to distill and communicate them clearly to inform our final product design. The proof of the project’s success lies in the adoption of the Cydar EV product by our customers into routine clinical use.”