Versatile, Reusable, and Inexpensive Ultrasound Phantom Procedural Trainers

Morrow, Dustin; Cupp, Julia; Broder, Joshua

doi:10.7863/ultra.15.04085

Cited by 34 publications

(31 citation statements)

References 23 publications

(43 reference statements)

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“…Ballistic gel is an inorganic substance, is non-perishable, may be re-used numerous times. Previous studies have demonstrated the echogenic properties of ballistic gel for imaging phantoms [ 25 , 26 ]. However, due to its higher melting point, the phantom will need to be printed from more heat tolerant materials, such as nylon.…”

Section: Discussionmentioning

confidence: 99%

Low-cost three-dimensional printed phantom for neuraxial anesthesia training: Development and comparison to a commercial model

et al. 2018

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Neuraxial anesthesia (spinal and epidural anesthesia) procedures have significant learning curves and have been traditionally taught at the bed side, exposing patients to the increased risk associated with procedures done by novices. Simulation based medical education allows trainees to repeatedly practice and hone their skills prior to patient interaction. Wide-spread adoption of simulation-based medical education for procedural teaching has been slow due to the expense and limited variety of commercially available phantoms. Free/Libre/open-source (FLOS) software and desktop 3D printing technologies has enabled the fabrication of low-cost, patient-specific medical phantoms. However, few studies have evaluated the performance of these devices compared to commercially available phantoms. This paper describes the fabrication of a low-cost 3D printed neuraxial phantom based on computed tomorography (CT) scan data, and expert validation data comparing this phantom to a commercially available model.MethodsAnonymized CT DICOM data was segmented to create a 3D model of the lumbar spine. The 3D model was modified, placed inside a digitally designed housing unit and fabricated on a desktop 3D printer using polylactic acid (PLA) filament. The model was filled with an echogenic solution of gelatin with psyllium fiber. Twenty-two staff anesthesiologists performed a spinal and epidural on the 3D printed simulator and a commercially available Simulab phantom. Participants evaluated the tactile and ultrasound imaging fidelity of both phantoms via Likert-scale questionnaire.ResultsThe 3D printed neuraxial phantom cost $13 to print and required 25 hours of non-supervised printing and 2 hours of assembly time. The 3D printed phantom was found to be less realistic to surface palpation than the Simulab phantom due to fragility of the silicone but had significantly better fidelity for loss of resistance, dural puncture and ultrasound imaging than the Simulab phantom.ConclusionLow-cost neuraxial phantoms with fidelity comparable to commercial models can be produced using CT data and low-cost infrastructure consisting of FLOS software and desktop 3D printers.

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Section: Discussionmentioning

confidence: 99%

Low-cost three-dimensional printed phantom for neuraxial anesthesia training: Development and comparison to a commercial model

et al. 2018

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“…The procedure for producing a lumbar spine phantom model composed of synthetic ballistic gelatine was based on the protocol described by Morrow et al[ 22 ], and slightly modified for purposes of the present study. The gel phantom was made by embedding a lumbosacral spine model (spine L2-sacrum; Sawbones Europe AB, Malmö, Sweden) in a 10% solution of clear ballistic gelatine (Clear Ballistics, LLC, Fort Smith, AR).…”

Section: Methodsmentioning

confidence: 99%

Ultrasound-guided lumbar puncture with a needle-guidance system: A prospective and controlled study to evaluate the learnability and feasibility of a newly developed approach

2018

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ObjectiveTo evaluate the learnability and feasibility of a new technique comprising a needle-guidance-system (NGS) for ultrasound-assisted lumbar puncture.MethodUsing a randomized crossover study design, 24 medical students were asked to perform an ultrasound-assisted lumbar puncture on a gel phantom using two different techniques that each included a paramedian insertion site. Procedure 1 (P1) used a pre-procedural ultrasound scan to predetermine the ideal insertion point. Procedure 2 (P2) applied a new technique comprising an NGS for performing real-time ultrasound-guided lumbar puncture. Success rates and performance times for both procedures were compared. Participants were also asked to complete a post-study questionnaire, both to quantitatively assess the workload involved and state their personal preferences.ResultsIn comparison to the pre-procedural scan (P1), the NGS (P2) was associated with a significant increase in the number of successful punctures per participant (5 (P2) [interquartile range: 3.3–5.0] vs. 3 (P1) [interquartile range: 1.3–4.0], p = 0.005), and led to a significant reduction in performance time (118 seconds vs. 80.6 seconds, p < 0.001). In terms of workload perception, NGS use was associated with significantly better performances and lower frustration levels, as rated by students in the post-study questionnaire. Finally, 23/24 participants stated their preference for P2.ConclusionOur newly-developed technique for real-time ultrasound-guided lumbar puncture proved to be learnable and feasible for novices, and only required a small amount of training. The use of an NGS therefore has the potential to serve as a key feature of the ultrasound-assisted lumbar puncture.

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“…With regard to mapping GSW tracks, the literature appears limited with examples of a case report [22] and a live animal model study [23]. There has been an increasing use of ballistic gelatine in models for ultrasound training, such as vessel cannulation or joint injection [24][25][26][27][28].…”

Section: Ultrasoundmentioning

confidence: 99%

“…Light and portable, the use of ultrasound is versatile, and is relatively cheap; however, the variation in images compounded by gas artefact and the presence of operator dependence made it challenging to demonstrate a scientifically reproducible series of results when examining the cadaveric animal material in this study. The addition of contrast improved the quality of images gathered, as the identification of fluid within a material of fixed echogenicity is where ultrasound as an imaging technique is able to excel [21,24,25,27,28]. GSW tracks with contrast injected could be identified within the deer limbs with relative ease; however, with gas remained a confounder and there was difficulty orientating images without a reliable reference point.…”

Section: Ultrasoundmentioning

confidence: 99%

Ballistic research techniques: visualizing gunshot wounding patterns

et al. 2020

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There are difficulties associated with mapping gunshot wound (GSW) patterns within opaque models. Depending on the damage measurement parameters required, there are multiple techniques that can provide methods of "seeing" the GSW pattern within an opaque model. The aim of this paper was to test several of these techniques within a cadaveric animal limb model to determine the most effective. The techniques of interest were flash X-ray, ultrasound, physical dissection, and computed-tomography (CT). Fallow deer hind limbs were chosen for the model with four limbs used for each technique tested. Quarantined 7.62 × 39 mm ammunition was used for each shot, and each limb was only shot once, on an outdoor range with shots impacting at muzzle velocity. Flash X-ray provided evidence of yaw within the limb during the projectile's flight; ultrasound though able to visualise the GSW track, was too subjective and was abandoned; dissection proved too unreliable due to the tissue being cadaveric so also too subjective; and lastly, CT with contrast provided excellent imaging in multiple viewing planes and 3D image reconstruction; this allowed versatile measurement of the GSW pattern to collect dimensions of damage as required. Of the different techniques examined in this study, CT with contrast proved the most effective to allow precise GSW pattern analysis within a cadaveric animal limb model. These findings may be beneficial to others wishing to undertake further ballistic study both within clinical and forensic fields.

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Versatile, Reusable, and Inexpensive Ultrasound Phantom Procedural Trainers

Cited by 34 publications

References 23 publications

Low-cost three-dimensional printed phantom for neuraxial anesthesia training: Development and comparison to a commercial model

Low-cost three-dimensional printed phantom for neuraxial anesthesia training: Development and comparison to a commercial model

Ultrasound-guided lumbar puncture with a needle-guidance system: A prospective and controlled study to evaluate the learnability and feasibility of a newly developed approach

Ballistic research techniques: visualizing gunshot wounding patterns

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