The Efficacy of Lumbosacral Spine Phantom to Improve Resident Proficiency in Performing Ultrasound-Guided Spinal Procedure

Development and promotion of a 3D-printed phantom model for ultrasound-guided caudal block followed by intracavitary/interstitial brachytherapy for gynecological cancer

PURPOSE

We developed a 3D-printed phantom model for ultrasound-guided caudal block for educational or training purposes because there have been no reports of the 3D-printed phantom model for ultrasound-guided caudal block. This study aimed to identify the needs for the phantom model in a lecture and demonstration at hands-on training (HoT) to promote the use of caudal block for sufficient pain control during high-dose-rate intracavitary/interstitial brachytherapy for gynecological cancers.

MATERIALS AND METHODS

The sacrum and formwork were designed by computed tomography imaging. A 3D-modeling software program was used to create the sacrum and formwork. The phantom was solidified by injecting a gelatin-based gel. Ultrasonography was performed to visualize the sacral hiatus and puncture needle in the phantom. In October 2023, 10 radiation oncologists who did not perform caudal block in daily clinical practice from ten Japanese facilities participated in HoT on ultrasound-guided caudal block. After the HoT, questionnaires were distributed to each participant, and feedback was obtained through online channels.

RESULTS

After receiving a lecture and demonstration on ultrasound-guided caudal block, 90% of the respondents would like to practice the procedure in their daily clinical practice. Moreover, 100% of the respondents would like to use the 3D-printed phantom model for ultrasound-guided caudal block for educational or training purposes.

CONCLUSION

The 3D-printed phantom model for ultrasound-guided caudal block can be used in training and is in demand for facilities introducing caudal block.

Interventional Spine Course: Improving Fluoroscopic Safety and Procedural Efficacy Among Physical Medicine and Rehabilitation Residents Using a Lecture and Model-Based Curriculum

ABSTRACT

Therapeutic interventional techniques using fluoroscopy are often used in the management of spinal pain. Currently, there are no standardized means of instruction and assessment of fluoroscopic interventional spinal procedures for physiatry trainees. The aim of our study is to evaluate the utility of an interventional spine training course for physical medicine and rehabilitation residents in improving safety and efficacy when performing these procedures. We performed a prospective multiple cohort study analyzing interventional spine knowledge and procedural ability among physical medicine and rehabilitation residents after implementing a training course that used lectures, hands-on training, and video-recorded objective structured clinical examination self-assessments. Of the total of 28 physical medicine and rehabilitation residents over the 2-yr study period, each class saw a statistically significant improvement in mean objective structured clinical examination scores from pre-examination to postexamination ( P < 0.05). Written examination scores also had a statistically significant preimprovement to postimprovement in the postgraduate years 2 and 3 classes. Our study supports the use of an interventional spine course for physical medicine and rehabilitation residents, and by following the existing cohorts and adding more cohorts in the future, we will continue to demonstrate valuable and comprehensive results.

Patient-Tailored 3D-Printing Models in the Subspecialty Training of Spinal Tumors: A Comparative Study and Questionnaire Survey

BACKGROUND

Training in the subspecialty of spinal tumors is challenging and less researched. The anatomic variations and complex relationship with paraspinal structures tend to be the main obstacle for the trainees in this field. Three-dimensional (3D)-printing technique has the advantage of individual customization and high fidelity, and can produce case-tailored models as auxiliary tools in medical training.

METHODS

The main parts of the study included case-based lectures with tailored 3D-printing models, evaluating their performances in a controlled examination and anonymous questionnaire survey regarding the trainees' opinion towards the tailored models. The examination was designed as case-based clinical analysis. All trainees were randomly allocated to the study group and control group, and the former group was additively provided a case-tailored model.

RESULTS

Thirty-six participants were recruited in this study, including 16 residents and 20 fellows. In the section of examination, there was significant difference in the aspects of describing the involvement of paraspinal structures and discriminating the relationship between the tumor and large vessels (P < 0.05), but similar in the aspects of surgical planning and relevant complications (P > 0.05). In the survey, most participants gave favorable responses to 3D-printing models in the aspects of understanding anatomic structures and relationship, inter-trainee communication, surgical planning, and enhancement of interest and confidence (50.0% to 94.4%, respectively).

CONCLUSIONS

The 3D-printing model is a valuable tool in the training of new residents and fellows in the subspecialty of spinal tumors. It can facilitate the trainees' understanding of tumor anatomy, surgical readiness, and confidence as well.

Creating Low-Cost Phantoms for Needle Manipulation Training in Interventional Radiology Procedures

Image-guided procedures play a critical role in the clinical practice of radiologists. Training radiology residents in these procedures, with early teaching of basic but fundamental skills, is therefore crucial to develop competence before they become autonomous and start their practice. It has been proposed in the literature that low-fidelity phantoms are appropriate to teach novice trainees. The authors propose a series of phantoms to teach the core skills necessary to perform procedures early in resident training. The phantoms described can be used to train skills necessary for performing US-guided biopsy, US-guided vascular puncture, cone-beam CT drainage, and fluoroscopy-guided lumbar puncture, as well as using the parallax effect to determine relative position at fluoroscopy. Phantoms are a valuable training tool, although it is important to consider the teaching audience when choosing or creating a model. For novices, a range of inexpensive low-fidelity gelatin-based phantoms can be used to train core skills in image-guided procedures. The online slide presentation from the RSNA Annual Meeting is available for this article. ^©RSNA, 2021.

Evaluating the effectiveness of a lower extremity venous phantom on developing ultrasound examination skills and confidence

Introduction

The aims of this study were: (1) Determine the effect on student ultrasound scanning skills using a lower extremity venous ultrasound phantom in addition to standard teaching methods of didactic lecture and scanning live volunteers and (2) Determine the effect of using a lower extremity venous ultrasound phantom in addition to standard teaching methods of didactic lecture and scanning live volunteers on student confidence levels in performing the lower extremity venous ultrasound examination.

Methods

Participants were first year diagnostic medical sonography students with minimal scanning experience (n = 11), which were randomized into two groups. Group 1 (n = 5) received the standard didactic lecture and attended a scan lab assessment where they performed a lower extremity venous examination on a human volunteer. Group 2 (n = 6) received the standard didactic lecture, performed three scheduled scanning sessions on an anatomic lower extremity venous phantom with flow and then attended the same scan lab assessment as Group 1, where they performed a lower extremity venous examination on a human volunteer.

Results

Scan lab assessments on day 4 of the study demonstrated a significant difference in scanning performance (p = 0.019) between the two groups. Post scan lab assessment confidence scores also demonstrated a significant difference between how participants in each group scored their confidence levels (p = 0.0260), especially in the ability to image calf veins.

Conclusions

This study suggests anatomical phantoms can be used to develop scanning skills and build confidence in ultrasound imaging of the lower extremity venous structures.

A Novel Three-Dimensional-Printed Ultrasound-Guided Hip Arthrocentesis Model

When evaluating patients with hip pain, clinicians may be trained to both evaluate for a hip effusion and perform ultrasound-guided arthrocentesis to evaluate the etiology of the effusion. We present a novel 3-dimensional-printed hip arthrocentesis model, which can be used to train clinicians to perform both tasks under ultrasound guidance. Our model uses a combination of a 3-dimensional-printed hip joint, as well as readily available materials such as an infant Ambu (Ballerup, Denmark) bag, syringe, intravenous line kit, and silicone. We present our experience so that others may use and adapt our model for their training purposes.

Comparison of Reusable Models in Pericardiocentesis Simulation Training

INTRODUCTION

Pericardiocentesis is a potentially life-saving procedure. We compared two low-cost models-an agar-based model and a novel model, Centesys-in terms of ultrasound image quality and realism, effectiveness of the model, and learners' confidence and satisfaction after training.

METHODS

In this pilot randomised 2x2 crossover trial stratified by physician seniority, participants were assigned to undergo pericardiocentesis training either with the agar-based or Centesys model first, followed by the other model. Participants were asked to rate their confidence in performing ultrasound-guided pericardiocentesis, clarity and realism of cardiac structures on ultrasound imaging, and satisfaction on a 7-point Likert scale before and after training with each model.

RESULTS

Twenty participants with median postgraduate year of 4 (interquartile range [IQR] 3.75-6) years were recruited. Pre-training, participants rated themselves a median score of 2.5 (IQR 2-4) for level of confidence in performing pericardiocentesis, which improved to 5 (IQR 4-6) post-training with Centesys (P=0.007). Centesys was recognised to be more realistic in simulating cardiac anatomy on ultrasound (median 5 [IQR 4-5] versus 3.5 [IQR 3-4], P=0.002) than the agar-based model. There was greater satisfaction with Centesys (median 5 [IQR 5-6] versus 4 [IQR 3.75-4], P<0.001). All 20 participants achieved successful insertion of a pericardial drain into the simulated pericardial sac with Centesys.

CONCLUSION

Centesys achieved greater learner satisfaction as compared to the agar-based model, and was an effective tool for teaching ultrasound-guided pericardiocentesis and drain insertion.

Improving Internal Medicine Resident Comfort With Shoulder and Knee Joint Injections Using an Injection Workshop

INTRODUCTION

Joint injections can be effective treatments for musculoskeletal issues. We examined whether a brief teaching session delivered to residents and faculty would significantly improve resident confidence in performing shoulder and knee joint injections.

METHODS

We implemented a 90-minute workshop instructed by two sports medicine providers. The objectives and content of the workshop included the topics of indications and contraindications, risks and benefits, supplies and setup, and injection techniques, all assessed on 5-point Likert scales. The workshop included a lecture, followed by residents practicing injections on simulation models and identifying key bony landmarks. Outpatient clinic faculty were given the same lecture and practiced on models. The postworkshop questionnaire was administered to the residents 4 months later.

RESULTS

Eighteen residents participated. Mean confidence for performing knee injections increased from 2.2 to 3.8 immediately postlecture (p = .006). Shoulder injection confidence increased from 1.6 to 3.8 immediately postlecture (p = .0002). Confidence in knowledge of the risks and benefits, supplies needed, and indications increased similarly. Four months postworkshop, confidence levels were sustained above pretesting levels for all areas studied. Faculty members appreciated their workshop since they had not often performed injections.

DISCUSSION

This brief workshop-style teaching session can provide meaningful, durable improvements in a trainee's confidence regarding performing shoulder or knee joint injections. The session requires few resources and fits into regular didactic sessions. Further development of this model could increase clinical performance and practice confidence and make these procedures more widely accessible to patients.

The efficacy of cervical spine phantoms for improving resident proficiency in performing ultrasound-guided cervical medial branch block: A prospective, randomized, comparative study

BACKGROUND

Few studies have been conducted on the utility of cervical spine phantoms for practicing cervical procedures. Here, we describe a simple method for creating a cervical spine phantom and investigate whether the use of a gelatin-based phantom is associated with improved proficiency in performing ultrasound-guided cervical medial branch block.

METHODS

A cervical spine phantom was prepared using a cervical spine model immersed in a mixture of gelatin and psyllium husk. In total, 27 participants, inexperienced in spinal ultrasonography, were enrolled and allocated to 1 of 2 groups (training group, n = 18; control group, n = 9). All participants were tested (test-1) following an introductory course of basic ultrasonography. Participants in the control group were tested again after 1 week (test-2). Those in the training group received a further individual 3-hour training session, and were tested again after 1 week (test-2).

RESULTS

The mean performance score in test-1 was 62.5 ± 10.1 points in the training group and 62.3 ± 4.1 points in the control group [95% confidence interval (95% CI) -5.5 to 5.8; P = .954]. In test-2, the mean score was 86.8 ± 6.5 points and 59.9 ± 4.4 points in the training and control groups, respectively (95% CI 21.9-31.8; P < .001). The mean time required to complete test-1 was 84.6 ± 26.6 seconds in training group and 90.7 ± 43.9 seconds in the control group (95% CI -34.0 to 21.7; P = .653); in test-2, the time required was 56.6 ± 27.9 and 91.2 ± 43.8 seconds (95% CI -63.0 to -6.2; P = .019), respectively. Interobserver reliability showed excellent agreement based on the intraclass correlation coefficient, and moderate to almost perfect agreement by kappa statistics.

CONCLUSION

Training using a gelatin-based cervical spine phantom helps novices acquire the skills necessary to perform ultrasound-guided cervical medial branch blocks.

Efficacy of using a 3D printed lumbosacral spine phantom in improving trainee proficiency and confidence in CT-guided spine procedures

Background

Minimally-invasive spine procedures provide targeted, individualized diagnosis and pain management for patients. Competence in these procedures is acquired through experience and training. We created a 3D printed model of a degenerative lumbosacral spine with scoliosis and spondylosis, using materials that mimic bone and soft tissue density under CT. In this study, we evaluate the efficacy of using such a spine model to improve novice trainee confidence and proficiency in performing CT-guided facet joint injections.

Results

Thirteen medical students with no prior exposure to CT-guided spine procedures were divided into two groups. Both groups received an introductory didactic lecture, as well as identical pre- and post- test assessments. The Training group (7 students) received two separate training sessions using the simulation model. The Control group (6 students) received only one training session. The Training group demonstrated significantly fewer needle readjustments during the second simulation session, compared with the first session (p = 0.005). Both groups demonstrated significant increase in confidence in ability to perform CT-guided spine procedures on the post-test (p = 0.004 for the Control group and p = 0.00001 for the Training group).

Conclusion

A 3D printed lumbosacral spine phantom with realistic spondylosis can be made to facilitate novice training in minimally-invasive spine procedures. Training using a realistic lumbosacral spine model helps novices acquire the skills and confidence to perform CT-guided spine procedures.

Gelatin Thoracic Paravertebral Teaching Model for Placement of a Continuous Infusion Catheter in the Extrathoracic Paravertebral Space

OBJECTIVE

Our aim was to develop an ultrasound-guided training curriculum for continuous infusion catheter placement in the paravertebral space and to create a gelatin thoracic spine-rib model for use in this training. We sought to create a model that was inexpensive and reusable such that multiple participants could use one model during training.

DESIGN

The model was prepared by embedding a firm foam thoracic spine replica with bilateral attached ribs into an opaque gelatin mixture. Once solidified, a preselected area was excised on each side, such that the model could be easily refilled with new gelatin blocks for use by each participant. This allowed for multiple participants to use the same model while eliminating confusion with prior tract marks.

SETTING

The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI.

PARTICIPANTS

Fifty-two medical students and general surgery residents underwent a 30-minute didactic session on ultrasound technique for catheter placement followed by practice on the gelatin model.

RESULTS

The texture and echogenicity of the model were subjectively comparable to those of tissue in vivo and the osseous elements of the spine in the model were clearly identified using ultrasound. The exchangeable catheter placement area provided an efficient and effective method to test accurate performance in catheter placement by multiple users. Participants increased their confidence in the use of ultrasound for this procedure.

CONCLUSIONS

To date, this is the first gelatin thoracic spine-rib model that has been used to teach ultrasound-guided catheter insertion into the paravertebral space, with removable testing areas that can be used by multiple users. This model can provide an inexpensive training tool that can be used in a surgical simulation setting.

The Principles and Procedures of Ultrasound-guided Anesthesia Techniques

For inexperienced users, training with phantoms is an important part of training. Inexperienced users can teach themselves to gain significant procedural skills. Participating in training courses or practising with experts can enhance the outcomes. Inexperienced users need to understand the indications, clinical pearls, and pitfalls of each procedure to avoid potential complications. Inexperienced users can also train and teach themselves to become proficient in ultrasound techniques.

Interventional Pain Procedures in Physical Medicine and Rehabilitation Residencies

Exposure to interventional pain procedures is now a required component of training in physical medicine and rehabilitation residencies as mandated by the Accreditation Council for Graduate Medical Education. Data regarding resident exposure and competency in these procedures remain limited. Objectives were to determine the volume and type of exposure physical medicine and rehabilitation residents have to interventional pain procedures and to obtain faculty-perceived opinions regarding competency of incoming fellows as it pertains to interventional pain management. Online surveys were sent to program directors of physical medicine and rehabilitation residencies and fellowship directors of interventional spine, sports medicine, and pain medicine fellowships. Surveys inquired about educational methods, the volume of procedures in which residents actively participate, and faculty-perceived competency of trainees performing procedures. Thirty-nine residency programs and 27 fellowships responded to the surveys. Of the 39 residencies that responded, there was great variation in the exposure residents receive. Most programs reported that residents have moderate exposure to common procedures such as ultrasound-guided knee injections and lumbar epidural injections. In addition, while most residency program directors report graduates to be "fairly prepared" (33%) to "well prepared" (20.5%) with regard to spine procedures, most fellowship directors (63%) describe incoming fellows to be at the "beginner" level.

Ultrasound Phantoms to Protect Patients from Novices

With the growing use of ultrasound for pain management, we are interested in how to teach and practice ultrasound-guided procedures. Ethically, we should not insert a needle in a patient until after much practice on a phantom. Several types of phantoms have been introduced for ultrasound training, including water, agar/gelatin, elastomeric rubber, and meat phantoms and cadavers. The ideal phantom is similar to human tissue, is readily available and inexpensive, can be used repeatedly, provides tactile feedback, will hold a needle in place, does not generate needle tracks, and is not a health hazard. Several studies have shown the effectiveness of phantoms for improving the proficiency of novices. We hope that the application of phantoms in education leads to improved proficiency and increased patient safety.