A Low-Cost, Reusable, Ballistic Gelatin Ultrasound Phantom for Simulation of Glenohumeral Intraarticular Injections

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.

[Anatomic joint models for eco-guided interventionism training manufacture]

INTRODUCTION

Eco-guided interventionism has changed the way Physical Medicine and Rehabilitation specialists deal with musculoskeletal pain and other problems such as spasticity. The implementation of the Eco-Guided Intervention Units improves the results of the usual minimally invasive treatments in our speciality's clinical practice. The biggest drawback of this practice is the long learning curve and the difficulty of practice during training courses.

OBJECTIVE

To develop a system of phantoms that allow the practice of interventionism in anatomical models by shortening learning times and improving certainty by achieving the objective of interventionist practice.

METHODS

Describes the method of manufacturing three-dimensional models of joints with images obtained from computerized axial tomography, and their subsequent inclusion in gelatin's made molds, which allow to obtain phantoms, similar to real joint models, that allow to study using ultrasound techniques, and the practice of eco-guided interventionism.

CONCLUSION

Three-dimensional joint models made with gelatin are useful in the practice and learning of joint eco-guided interventionism techniques.

A High-Fidelity Percutaneous Model Used to Demonstrate ECMO Cannulation

Medical simulation provides a realistic environment for practitioners to experience a planned clinical event in a controlled educational setting. We established a simulation model composed of synthetic ballistic gelatin that provided an inexpensive high-fidelity model for our extracorporeal membrane oxygenation (ECMO) team members to develop, master, and maintain clinical skills necessary for percutaneous cervical or femoral cannulation. The simulation component includes a cervical torso or femoral percutaneous synthetic gelatin model that is attached to either a static fluid model or to the high-fidelity perfusion simulator. Either model can be accessed with ultrasound guidance, cannulated with appropriately sized cannula, and connected to an in situ ECMO circuit. This article explains how the model is made and connected to the simulator with the purpose of re-creating this high-fidelity experience at any institution.

A Novel, Reusable, Ultrasound-Guided Pericardiocentesis Simulation Model

Given the rarity of emergency pericardiocentesis, deliberate effort must be made by the physician to maintain competence in performing this procedure. Herein we describe the construction of a low-cost, reusable, high-fidelity simulation model for ultrasound-guided pericardiocentesis. Sixteen emergency medicine residents participated in a procedure lab using the model and then evaluated the model's efficacy using a survey. Results of this survey found that most participants believed that the model was easy to use and that it increased their competency. There was also a significant increase in self-reported Likert-rated confidence in performing pericardiocentesis before and after simulation (1.63 to 3.81; P < .001).

Cadaveric Simulation Training Improves Residents' Knowledge and Confidence in Performing Fluoroscopic Guided Joint Injections

RATIONALE AND OBJECTIVE

Simulation training has been strongly encouraged to enhance radiology trainees' procedural competency. We aimed to assess whether a cadaveric simulation training session was effective in improving radiology residents' subjective technical ability, knowledge and confidence in performing fluoroscopic-guided joint injections.

METHODS

As part of the residency program's procedural training curriculum, first year radiology resident participated in a cadaveric, musculoskeletal injection training session including a didactic lecture followed by a practical hands-on component. Trainees performed fluoroscopic guided hip and shoulder injections on fresh cadavers, supervised by two fellowship-trained musculoskeletal radiologists. Trainees' knowledge on indications, contraindications, preprocedural care, complications, and technical ability in performing the procedures, as well as their rating of overall session experience were evaluated with pre- and post-session questionnaires (5 point Likert-scale). The mean residents' scores for pre- and post-session questionnaire items were calculated and compared using paired t-test. The magnitude of difference between mean pre- and post-session scores was compared between the items using analysis of variance.

RESULTS

Results Over a 5-year period, 27 trainees participated in the joint injection simulation session. The mean pre- and post-session scores were significantly higher in the post session questionnaire for all five items pertaining to knowledge of indications, contraindications, preprocedural care, complications, and technical ability (all p < 0.0001). The magnitude of improvement was not different between the items (p = 0.45). Most of the participants rated the training facilities, contents, hands-on experience, teaching quality, and session organization as very good or excellent.

CONCLUSIONS

Cadaveric joint injection simulation training significantly improved trainees' subjective knowledge, confidence, and technical ability in performing joint injections.

Ballistic research techniques: visualizing gunshot wounding patterns

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.