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Kong B, Zabadayev S, Perese J, Panag A, Jafry Z. Ultrasound-Guided Fascia Iliaca Compartment Block Simulation Training in an Emergency Medicine Residency Program. Cureus 2024; 16:e52411. [PMID: 38371018 PMCID: PMC10869949 DOI: 10.7759/cureus.52411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Geriatric hip fractures present a difficult challenge in the emergency department (ED) to achieve adequate analgesia. Opioid-sparing ultrasound-guided fascia iliaca compartment blocks (UFIB) have been shown to be both safe and effective in treating pain from hip fractures. In this study, we investigated the teachability of UFIB to emergency medicine (EM) residents using simulation models and also assessed if UFIB training increases its utility in the ED. Methods We created a UFIB model to simulate the procedure in a controlled environment. Sixteen residents from Loma Linda Emergency Medicine Residency participated in a pre-workshop survey and hands-on UFIB workshop. Comfort level in performing UFIB and confidence level in needle finding skills during UFIB were analyzed, plotted, and represented graphically. Results Comfort level in performing UFIB increased by approximately 50% (p < 0.01). Success rates also increased by 460% (p<0.05) after the workshop. However, the UFIB continued to be underutilized as 44% of respondents expressed that there is a "lack of time" to perform UFIB during their shifts. Conclusion A single one-hour workshop increased comfort level in performing UFIB and helped residents successfully achieve better pain control in patients with hip fractures. However, residents continued to refrain from using UFIB because it is too time-consuming.
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Affiliation(s)
- Bumin Kong
- Emergency Department, Loma Linda University Medical Center, Loma Linda, USA
| | - Sophia Zabadayev
- Emergency Department, Loma Linda University Medical Center, Loma Linda, USA
| | - Joshua Perese
- Emergency Department, Loma Linda University Medical Center, Loma Linda, USA
| | - Ajit Panag
- Emergency Department, Loma Linda University Medical Center, Loma Linda, USA
| | - Zan Jafry
- Emergency Department, Loma Linda University Medical Center, Loma Linda, USA
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Albor-Ramírez E, Reyes-Alberto M, Vidal-Flores LM, Gutierrez-Herrera E, Padilla-Castañeda MA. Agarose Gel Characterization for the Fabrication of Brain Tissue Phantoms for Infrared Multispectral Vision Systems. Gels 2023; 9:944. [PMID: 38131930 PMCID: PMC10742522 DOI: 10.3390/gels9120944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Synthetic phantoms that recreate the characteristics of biological tissues are valuable tools for systematically studying and comprehending physiologies, pathologies, and biological processes related to tissues. The reproduction of mechanical and optical properties allows for the development and evaluation of novel systems and applications in areas such as imaging, optics, ultrasound, or dosimetry, among others. This paper proposes a methodology for manufacturing agarose-based phantoms that mimics the optical properties of healthy brain tissue within the wavelength infrared range of 800 to 820 nm. The fabrication of such phantoms enables the possibility of testing and experimentation in controlled and safe environments toward the design of new near-infrared multispectral imaging systems in neurosurgery. The results of an experimental optical characterization study indicate the validity and reliability of the proposed method for fabricating brain tissue phantoms in a cost-effective and straightforward fashion.
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Affiliation(s)
| | - Miguel Reyes-Alberto
- Applied Sciences and Technology Institute ICAT, National Autonomous University of Mexico UNAM, Ciudad Universitaria, Mexico City 04510, Mexico; (E.A.-R.); (L.M.V.-F.); (E.G.-H.)
| | | | | | - Miguel A. Padilla-Castañeda
- Applied Sciences and Technology Institute ICAT, National Autonomous University of Mexico UNAM, Ciudad Universitaria, Mexico City 04510, Mexico; (E.A.-R.); (L.M.V.-F.); (E.G.-H.)
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Jiang B, Wang L, Xu K, Hossbach M, Demir A, Rajan P, Taylor RH, Moghekar A, Foroughi P, Kazanzides P, Boctor EM. Wearable Mechatronic Ultrasound-integrated AR Navigation System for Lumbar Puncture Guidance. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2023; 5:966-977. [PMID: 38779126 PMCID: PMC11107797 DOI: 10.1109/tmrb.2023.3319963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
As one of the most commonly performed spinal interventions in routine clinical practice, lumbar punctures are usually done with only hand palpation and trial-and-error. Failures can prolong procedure time and introduce complications such as cerebrospinal fluid leaks and headaches. Therefore, an effective needle insertion guidance method is desired. In this work, we present a complete lumbar puncture guidance system with the integration of (1) a wearable mechatronic ultrasound imaging device, (2) volume-reconstruction and bone surface estimation algorithms and (3) two alternative augmented reality user interfaces for needle guidance, including a HoloLens-based and a tablet-based solution. We conducted a quantitative evaluation of the end-to-end navigation accuracy, which shows that our system can achieve an overall needle navigation accuracy of 2.83 mm and 2.76 mm for the Tablet-based and the HoloLens-based solutions, respectively. In addition, we conducted a preliminary user study to qualitatively evaluate the effectiveness and ergonomics of our system on lumbar phantoms. The results show that users were able to successfully reach the target in an average of 1.12 and 1.14 needle insertion attempts for Tablet-based and HoloLens-based systems, respectively, exhibiting the potential to reduce the failure rates of lumbar puncture procedures with the proposed lumbar-puncture guidance.
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Affiliation(s)
- Baichuan Jiang
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Liam Wang
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Keshuai Xu
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - Alican Demir
- Clear Guide Medical Inc., Baltimore, MD 21211, USA
| | | | - Russell H. Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins Medical Institute, Baltimore, MD 21205, USA
| | | | - Peter Kazanzides
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Emad M. Boctor
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
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Hey MT, Masimbi O, Shimelash N, Alayande BT, Forbes C, Twizeyimana J, Nimbabazi O, Giannarikas P, Hamzah R, Eyre A, Riviello R, Bekele A, Anderson GA. Simulation-Based Breast Biopsy Training Using a Low-Cost Gelatin-Based Breast Model in Rwanda. World J Surg 2023; 47:2169-2177. [PMID: 37156884 DOI: 10.1007/s00268-023-07038-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy and assessed first-time user experience. METHODS An interdisciplinary team of healthcare providers and simulation specialists adopted and modified a protocol for the creation of a low-cost, gelatin-based breast model for teaching ultrasound-guided breast biopsy for approximately $4.40 USD. Components include medical-grade gelatin, Jell-O™, water, olives, and surgical gloves. The model was used to train two cohorts comprising 30 students total during their junior surgical clerkship. The learners' experience and perceptions on the first Kirkpatrick level were evaluated using pre- and post-training surveys. RESULTS Response rate was 93.3% (n = 28). Only three students had previously completed an ultrasound-guided breast biopsy, and none had prior exposure to simulation-based breast biopsy training. Learners that were confident in performing biopsies under minimal supervision rose from 4 to 75% following the session. All students indicated the session increased their knowledge, and 71% agreed that the model was an anatomically accurate and appropriate substitute to a real human breast. CONCLUSIONS The use of a low-cost gelatin-based breast model was able to increase student confidence and knowledge in performing ultrasound-guided breast biopsies. This innovative simulation model provides a cost-effective and more accessible means of simulation-based training especially for low- and middle-income settings.
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Affiliation(s)
- Matthew T Hey
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Ornella Masimbi
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
- Simulation and Skills Center, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Natnael Shimelash
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
- Simulation and Skills Center, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Barnabas T Alayande
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Jonas Twizeyimana
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
- Simulation and Skills Center, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Othniel Nimbabazi
- University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
- Global Health Corps, New York City, NY, 10001, USA
- Ministry of Health, Kicukiro, KN 3 RD, P.O Box 84, Kigali, Rwanda
| | - Persephone Giannarikas
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, 10 Vining Street, Boston, MA, 02115, USA
| | - Radzi Hamzah
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Andrew Eyre
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, 10 Vining Street, Boston, MA, 02115, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Avenue, 5Th Floor, P.O. Box 6955, Kigali, Rwanda.
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Ienghong K, Cheung LW, Wongwan P, Apiratwarakul K. Smart Glasses to Facilitate Ultrasound Guided Peripheral Intravenous Access in the Simulation Setting for Thai Emergency Medical Service Providers. J Multidiscip Healthc 2023; 16:2201-2206. [PMID: 37547807 PMCID: PMC10404035 DOI: 10.2147/jmdh.s424487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose The ultrasound-guided peripheral venous access (USGPIV) was reported as difficult for novices to perform. Smart glasses equipped with teleconference systems can display real-time ultrasound images to sonographers and consultants which can increase the success rate of this procedure. The purpose of this study was to assess the effectiveness of employing smart glasses for USGPIV. Patients and Methods A randomized, simulation study was conducted in emergency medical service (EMS) providers at Srinagarind Hospital, Thailand, from January to April 2023. We randomized participants into two groups which included participants who wore smart glasses during procedures requiring USGPIV (the smart glasses group) and participants who performed USGPIV with no smart glasses (the non-smart glasses group). After participating in USGPIV cannulation training, the simulations were carried out. The primary outcome was the first-attempt success rate, with secondary outcomes including the procedure time and subjective difficulty. Results Fifty participants were recruited for the study. The smart glasses group was superior to the non-smart glasses group both in terms of first-attempt success rate with no statistically significant (64% vs 60%; P = 0.460) and also demonstrated a shorter procedure time than the non-smart glasses group (25.5 sec vs 42.3 sec; P = 0.003). The participants reported the subjective difficulty score was higher in the smart glasses group (the visual analog scale, VAS = 8). Conclusion In simulation scenarios, the smart glasses-assisted USGPIV could shorten the procedure time. However, our study did not find significant differences in the first pass success rate of USGPIV between the two groups.
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Affiliation(s)
- Kamonwon Ienghong
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lap Woon Cheung
- Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong
- Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Pornpawit Wongwan
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Korakot Apiratwarakul
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Berdida DJE, Elero FSL, Donato MFT, Dungo MKS, Dunque NIO, Dy KJE, Elarmo RAGF, Espineli JMB, Espineli VJG. Filipino nursing students' use of low-cost simulators during the COVID-19 pandemic: A summative content analysis of YouTube videos. TEACHING AND LEARNING IN NURSING : OFFICIAL JOURNAL OF THE NATIONAL ORGANIZATION FOR ASSCIATE DEGREE NURSING 2023; 18:134-143. [PMID: 35999891 PMCID: PMC9388447 DOI: 10.1016/j.teln.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
This study examined Filipino nursing students' use of household materials as low-cost simulators and how they aid in online return demonstrations. Summative content analysis guided this study. We collected uploaded YouTube videos (n = 14) depicting Filipino nursing students using low-cost simulators in their skills demonstration. We used Bengtsson's approach to content analysis to analyze the data. Four themes of low-cost simulators were identified: home and hardware, health and beauty, creative articles, and entertainment. The categories under home and hardware were tools, containers, furniture, and packaging. Health and beauty low-cost simulators were toiletries and medical supplies. Creative articles included fabrics, clothing accessories, and stationeries. Entertainment low-cost-simulators had toys and computer accessories. During the COVID-19 pandemic, our research uncovered home equipment employed as low-cost simulators to help nursing students' online simulation of skills demonstration. We recommend further investigation of whether students learned using low-cost simulators.
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Kunhahamed M, Abraham S, Melit R, Krishnan SV, George T, Kassyap CK, Bhoi S, Sinha T. Indigenously developed ultrasound phantom model versus a commercially available training model: randomized double-blinded study to assess its utility to teach ultrasound guided vascular access in a controlled setting. J Med Ultrasound 2022; 30:11-19. [PMID: 35465598 PMCID: PMC9030346 DOI: 10.4103/jmu.jmu_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/20/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The commercially available training phantoms being expensive, homemade models are popular surrogates for training. We intended to study how comparable our indigenously developed ultrasound phantom (IDUP) was with the commercially available model for ultrasound-guided vascular access (USGVA) training. We also assessed the change in confidence among trainees using a 21-h standardized program. Methods: A prospective randomized double-blinded, parallel design study, with sequential allocation, was done after a standardized point of care ultrasound training course. Over three consecutive courses, 48 trainees volunteered to take part in the study. The models (IDUP and commercial phantom) were allocated as model A and model B. In each course, participants were also allotted sequentially to either perform in-plane or out of plane approach first, at the testing stations. Wilcoxon signed-rank test was used to compare pretest with posttest scores. Results: There was a statistically significant difference between IDUP and commercial phantom with respect to the resemblance to human tissue on tactile feedback and ease to perform the procedure. However, both models did not show a statistically significant difference in terms of ease of use, visual resemblance to human tissue, needle visualization, and artifacts on ultrasonography display. A significant change in the confidence levels of participants was seen postcourse. Conclusion: IDUP was a comparable alternative to the commercial model for USGVA training in a resource-limited setting. A 21-h standardized training program improved the trainee's confidence in performing and teaching USGVA.
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Development and Remodeling of Point-of-Care Ultrasound Education for Emergency Medicine Residents in Resource Limited Countries during the COVID-19 Pandemic. Tomography 2021; 7:721-733. [PMID: 34842824 PMCID: PMC8628902 DOI: 10.3390/tomography7040060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
The administration of an accurate and effective POCUS course is a crucial tool in improving health education and thus the health care system in low- to middle-income countries. The development of the ultrasound curriculum in these countries during the pandemic era is a major challenge for medical educators. Therefore, this study aims to survey the learner experience after implementing the POCUS curriculum for first-year emergency medicine residents. All learners responded to the survey. Our results demonstrated that the ultrasound rotation and our ultra-sound learning materials were useful tools which showed a positive impact on POCUS knowledge for our learners. However, some obstacles of POCUS learning were identified to assist in closing faculty development gaps, including the availability of handheld devices, as well as the re-modeling of the ultrasound rotation course, which should be managed according to the feedback we received. This study demonstrated a clear need for constant updates in higher education, medical program development, accuracy of local learning materials, and the explosion of virtual and online learning platforms during this decade.
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Abstract
The ultrasound phantoms used to educate medical students should not only closely mimic the ultrasound characteristics of human soft tissues but also be inexpensive and easy to manufacture. I have been studying handmade ultrasound phantoms and proposed an ultrasound phantom comprising calcium alginate hydrogel that met these requirements but caused a speckle pattern similar to that observed in ultrasound images of liver. In this study, I show that adding ethanol to the precursors used to fabricate the phantom reduces the speckle pattern. The ultrasound propagation velocity and attenuation coefficient of the phantom were 1561 ± 8 m/s and 0.54 ± 0.18 dB/cm/MHz, respectively (mean ± standard deviation), which are within the ranges of those in human soft tissues (1530-1600 m/s and 0.3-1.0 dB/cm/MHz, respectively). This phantom is easy to fabricate without special equipment, is inexpensive, and is suitable for elementary training on ultrasound diagnosis, operation of ultrasound-guided needles, and blind catheter insertion.
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Affiliation(s)
- Minoru Aoyagi
- Department of Electrical and Electronics Engineering, Nippon Institute of Technology, Miyashiro, Saitama, Japan
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Shin KC, Ha YR, Lee SJ, Ahn JH. Review of simulation model for education of point-of-care ultrasound using easy-to-make tools. World J Clin Cases 2020; 8:4286-4302. [PMID: 33083388 PMCID: PMC7559657 DOI: 10.12998/wjcc.v8.i19.4286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is a powerful diagnostic tool and provides treatment guidelines in acute critical settings. However, the limitation of using POCUS is operator dependent. Appropriate and validated training for acquiring and using skills in practice must be conducted before using POCUS in clinical settings in order to keep patients safe. Simulation education models have been introduced as a way to solve and overcome these concerns. However, the commercial simulator with sufficiently secured fidelity is expensive and not always available. This review focused on the inexpensive and easily made simulators for education on POCUS in critical specific situations related to the airway, breathing, circulation, and disability. We introduced the simulators that used non-infectious materials, with easily transportable features, and that had a sonographic appearance reproducibility similar to human tissue. We also introduced the recipe of each simulator in two parts: Materials surrounding disease simulators (surrounding materials) and specific disease simulators themselves (target simulators). This review article covered the following: endotracheal or oesophageal intubation, lung (A-lines, B-lines, lung sliding, and pleural effusions such as hemothorax), central vein access, pericardial fluid (cardiac tamponade), the structure related to the eyes, soft tissue abscess, nerve (regional nerve block), and skull fracture simulators.
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Affiliation(s)
- Kyu Chul Shin
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
| | - Young Rock Ha
- Department of Emergency Medicine, Bundang Jesaeng Hospital, Seongnam-si 13590, South Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Gyeonggi-do, South Korea
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Murthy SS, Ntakiyiruta G, Ntirenganya F, Ingabire A, Defregger SK, Reznor G, Lipitz S, Troyan SL, Raza S, Dunnington G, Riviello R. A Randomized Cross-Over Trial Focused on Clinical Breast Exam Skill Acquisition Using High Fidelity versus Low Fidelity Simulation Models in Rwanda. JOURNAL OF SURGICAL EDUCATION 2020; 77:1161-1168. [PMID: 32241670 DOI: 10.1016/j.jsurg.2020.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 02/24/2020] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Breast cancer incidence is rising for women in low and middle income country (LMIC)s. Growing the health care workforce trained in clinical breast exam (CBE) is critical to mitigating breast cancer globally. We developed a CBE simulation training course and determined whether training on a low-fidelity (LF) simulation model results in similar skill acquisition as training on high-fidelity (HF) models in Rwanda. DESIGN A single-center randomized educational crossover trial was implemented. A preintervention baseline exam (exam 1), followed by a lecture series (exam 2), and training sessions with assigned simulation models was implemented (exam 3)-participants then crossed over to their unassigned model (exam 4). The primary outcome of this study determined mean difference in CBE exam scores between HF and LF groups. Secondary outcomes identified any provider level traits and changes in overall scores. SETTING The study was implemented at the University Teaching Hospital, Kigali (CHUK) in Rwanda, Africa from July 2014 to March 2015 PARTICIPANTS: Medical students, residents in surgery, obstetrics and gynecology, and internal medicine residents participated in a 1-day CBE simulation training course. RESULTS A total of 107 individuals were analyzed in each arm of the study. Mean difference in exam scores between HF and LF models in exam 1 to 4 was not significantly different (exam 1 0.08 standard error (SE) = 0.47, p = 0.42; exam 2 0.86, SE = 0.69, p = 0.16; exam 3 0.03, SE = 0.38, p = 0.66; exam 4 0.10 SE = 0.37, p = 0.29). Overall exam scores improved from pre- to post-intervention. CONCLUSIONS Mean difference in exams scores were not significantly different between participants trained with HF versus LF models. LF models can be utilized as cost effective teaching tools for CBE skill acquisition, in resource poor areas.
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Affiliation(s)
- Shilpa Shree Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Indiana University, Bloomington, Indiana.
| | | | | | | | - Sara Kikut Defregger
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Indiana University, Bloomington, Indiana; University of Rwanda, Department of Surgery, Rwanda; Massachusetts General Hospital, Boston, Massachusetts; Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Gally Reznor
- Massachusetts General Hospital, Boston, Massachusetts
| | - Stu Lipitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Lynn Troyan
- Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Sughra Raza
- Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts
| | | | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, Department of Surgery, Rwanda
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Sarcopenia Detection System Using RGB-D Camera and Ultrasound Probe: System Development and Preclinical In-Vitro Test. SENSORS 2020; 20:s20164447. [PMID: 32784914 PMCID: PMC7472485 DOI: 10.3390/s20164447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/17/2022]
Abstract
Sarcopenia is defined as muscle mass and strength loss with aging. As places, such as South Korea, Japan, and Europe have entered an aged society, sarcopenia is attracting global attention with elderly health. However, only few developed devices can quantify sarcopenia diagnosis modalities. Thus, the authors developed a sarcopenia detection system with 4 degrees of freedom to scan the human thigh with ultrasound probe and determine whether he/she has sarcopenia by inspecting the length of muscle thickness in the thigh by ultrasound image. To accurately measure the muscle thickness, the ultrasound probe attached to the sarcopenia detection system, must be moved angularly along the convex surface of the thigh with predefined pressure maintained. Therefore, the authors proposed an angular thigh scanning method for the aforementioned reason. The method first curve-fits the angular surface of the subject’s thigh with piecewise arcs using D information from a fixed RGB-D camera. Then, it incorporates a Jacobian-based ultrasound probe moving method to move the ultrasound probe along the curve-fitted arc and maintains radial interface force between the probe and the surface by force feedback control. The proposed method was validated by in-vitro test with a human thigh mimicked ham-gelatin phantom. The result showed the ham tissue thickness was maintained within approximately 26.01 ± 1.0 mm during 82° scanning with a 2.5 N radial force setting and the radial force between probe and surface of the phantom was maintained within 2.50 ± 0.1 N.
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Singh V, Shaikh S, Shetty P, Moiyadi A. Customized Low-Cost Model for Hands-on Training in Intraoperative Ultrasound for Neurosurgeons: Our Experience and Review of Literature. World Neurosurg 2020; 143:564-571.e2. [PMID: 32679356 DOI: 10.1016/j.wneu.2020.07.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Practical ultrasound (US) training is essential to overcome operator dependence and optimize image acquisition. For intraoperative neurosurgical application, in addition to hand-eye coordination, ultrasound training should incorporate training for visuomotor and visuospatial skills, as well as 3-dimensional depth orientation. Our agar-based, low-cost model has been developed keeping these skill sets in mind. MATERIALS AND METHODS We have described preparation of an agar-based, low-cost customizable model using commonly available echogenic objects as targets, which allows the clinician to perform various training tasks like depth insonation, target localization, and biopsy and resection cavity insonation. This low-cost model was implemented for internal training and validated at an international training course. RESULTS The cost of the model was 4 USD, and its preparation time was <1 hour. It can be used for performing multiple US training tasks and provides realistic images and good tactile feedback. However, the model is perishable and artifacts are occasionally visible. Feedback survey results showed that >80% of participants felt the model was useful for US training. CONCLUSIONS Our customizable low-cost US training model is an effective and efficient tool for US training with high acceptance by neurosurgeons. It faithfully mimics various intraoperative tasks and helps clinicians gain confidence to use intraoperative ultrasound as an adjunct during the procedures. This model can be used by individual surgeons/departments for ongoing training, as well as for larger training courses and workshops.
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Affiliation(s)
- Vikas Singh
- Neurosurgical Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Salman Shaikh
- Neurosurgical Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Maharashtra, India
| | - Prakash Shetty
- Neurosurgical Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aliasgar Moiyadi
- Neurosurgical Oncology Services, Department of Surgical Oncology, Tata Memorial Hospital, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Murthy SS, Ntirenganya F, Scott JW, Ingabire A, Rosman D, Raza S, Troyan S, Dunnington G, Reznor G, Lipitz S, Ntakiyiruta G, Riviello R. A Randomized Cross-Over Trial Focused on Breast Core Needle Biopsy Skill Acquisition and Safety Using High Fidelity Versus Low Fidelity Simulation Models in Rwanda. JOURNAL OF SURGICAL EDUCATION 2020; 77:404-412. [PMID: 31902690 DOI: 10.1016/j.jsurg.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/07/2019] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer diagnosed in low and middle-income countries. Growing the number of health care personnel trained in diagnostic procedures like breast core needle biopsy (BCNB) is critical. We developed a BCNB simulation-training course that evaluated skill acquisition, confidence, and safety, comparing low-cost low fidelity (LF) models to expensive high fidelity (HF) models. DESIGN A single-center randomized education crossover trial was implemented. Participants were randomized to HF or LF groups. A preintervention baseline exam followed by lectures and training sessions with a HF or LF model was implemented. A postintervention simulation exam was conducted, and participants crossed over to the other simulation model. SETTING The study was implemented at the University Teaching Hospital, Kigali (CHUK) in Rwanda, Africa from October 2014 to March 2015. PARTICIPANTS Residents training in surgery or obstetrics and gynecology participated in a 1-day BCNB training course. RESULTS A total of 36 residents were analyzed, 19 in the HF arm and 17 in the LF arm. Mean difference in exam scores for HF and LF groups in the baseline exam (exam 1) (0.067, p = 0.94, standard error [SE] of 1.57) postintervention exam (exam 2) (1.85, SE 1.46, p = 0.33), and the crossover exam (exam 3) (4.39, SE = 1.90, p = 0.11) were not significantly different between HF and LF. Overall exam scores improved from pre- to postintervention. CONCLUSIONS Our results indicate that mean difference in exams scores were not significantly different between residents trained with HF versus LF models. In resources poor areas-LF models can be utilized as effective teaching tools for skill acquisition for diagnostic surgical procedures.
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Affiliation(s)
- Shilpa S Murthy
- Indiana University, Department of Surgery, Bloomington, Indiana; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | | | - John W Scott
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Allen Ingabire
- University of Rwanda, Department of Surgery, Kigali, Rwanda
| | - David Rosman
- Massachusetts General Hospital, Boston, Massachusetts
| | - Sughra Raza
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Susan Troyan
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gary Dunnington
- Indiana University, Department of Surgery, Bloomington, Indiana
| | - Gally Reznor
- Massachusetts General Hospital, Boston, Massachusetts
| | - Stu Lipitz
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Robert Riviello
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; University of Rwanda, Department of Surgery, Kigali, Rwanda
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de Jong L, Welleweerd MK, van Zelst JCM, Siepel FJ, Stramigioli S, Mann RM, de Korte CL, Fütterer JJ. Production and clinical evaluation of breast lesion skin markers for automated three-dimensional ultrasonography of the breast: a pilot study. Eur Radiol 2020; 30:3356-3362. [PMID: 32060713 PMCID: PMC7248012 DOI: 10.1007/s00330-020-06695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 11/24/2022]
Abstract
Objectives Automated ultrasound of the breast has the advantage to have the whole breast scanned by technicians. Consequently, feedback to the radiologist about concurrent focal abnormalities (e.g., palpable lesions) is lost. To enable marking of patient- or physician-reported focal abnormalities, we aimed to develop skin markers that can be used without disturbing the interpretability of the image. Methods Disk-shaped markers were casted out of silicone. In this IRB-approved prospective study, 16 patients were included with a mean age of 57 (39–85). In all patients, the same volume was imaged twice using an automated breast ultrasound system, once with and once without a marker in place. Nine radiologists from two medical centers filled scoring forms regarding image quality, image interpretation, and confidence in providing a diagnosis based on the images. Results Marker adhesion was sufficient for automated scanning. Observer scores showed a significant shift in scores from excellent to good regarding diagnostic yield/image quality (χ2, 15.99, p < 0.01), and image noise (χ2, 21.20, p < 0.01) due to marker presence. In 93% of cases, the median score of observers “agree” with the statement that marker-induced noise did not influence image interpretability. Marker presence did not interfere with confidence in diagnosis (χ2, 6.00, p = 0.20). Conclusion Inexpensive, easy producible skin markers can be used for accurate lesion marking in automated ultrasound examinations of the breast while image interpretability is preserved. Any marker-induced noise and decreased image quality did not affect confidence in providing a diagnosis. Key Points • The use of a skin marker enables the reporting radiologist to identify a location which a patient is concerned about. • The developed skin marker can be used for accurate breast lesion marking in ultrasound examinations.
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Affiliation(s)
- Leon de Jong
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands.
| | - Marcel K Welleweerd
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Jan C M van Zelst
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
| | - Francoise J Siepel
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Stefano Stramigioli
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
| | - Chris L de Korte
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, internal postal code 766, 6500 HB, Nijmegen, The Netherlands
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Elvira L, Durán C, Higuti RT, Tiago MM, Ibáñez A, Parrilla M, Valverde E, Jiménez J, Bassat Q. Development and Characterization of Medical Phantoms for Ultrasound Imaging Based on Customizable and Mouldable Polyvinyl Alcohol Cryogel-Based Materials and 3-D Printing: Application to High-Frequency Cranial Ultrasonography in Infants. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2226-2241. [PMID: 31128769 DOI: 10.1016/j.ultrasmedbio.2019.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
This work presents an affordable and easily customizable methodology for phantom manufacturing, which can be used to mimic different anatomic organs and structures. This methodology is based on the use of polyvinyl alcohol-based cryogels as a physical substitute for biologic soft tissues and of 3-D printed polymers for hard tissues, moulding and supporting elements. Thin and durable soft-tissue mimicking layers and multilayer arrangements can be obtained using these materials. Special attention was paid to the acoustic properties (sound speed, attenuation coefficient and mechanical impedance) of the materials developed to simulate soft tissues. These properties were characterized as a function of the additives concentration (propylene-glycol and alumina particles). The polyvinyl alcohol formulation proposed in this work is stable over several freeze-thaw cycles, allowing the manufacturing of multilayer materials with controlled properties. The manufacturing methodology presented was applied to the development of a phantom for high-frequency cranial ultrasonography in infants. This phantom was able to reproduce the main characteristics of the ultrasound images obtained in neonates through the anterior fontanel, down to 8-mm depth.
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Affiliation(s)
- Luis Elvira
- Instituto de Tecnologías Físicas y de la Información, CSIC, Madrid, Spain.
| | - Carmen Durán
- Instituto de Tecnologías Físicas y de la Información, CSIC, Madrid, Spain
| | - Ricardo T Higuti
- Univ Estadual Paulista, Campus of Ilha Solteira, Departament of Electrical Engineering, São Paulo, Brazil
| | - Marcelo M Tiago
- Federal University of Ouro Preto (UFOP), Department of Electrical Engineering, João Monlevade, Minas Gerais, Brazil
| | - Alberto Ibáñez
- Instituto de Tecnologías Físicas y de la Información, CSIC, Madrid, Spain
| | | | - Eva Valverde
- Unidad de Neonatología, Hospital La Paz, Madrid, Spain
| | - Javier Jiménez
- New Born Solutions, Barcelona Scientific Park, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
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Naraghi L, Lin J, Odashima K, Buttar S, Haines L, Dickman E. Ultrasound-guided regional anesthesia simulation: use of meat glue in inexpensive and realistic nerve block models. BMC MEDICAL EDUCATION 2019; 19:145. [PMID: 31092233 PMCID: PMC6521358 DOI: 10.1186/s12909-019-1591-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/02/2019] [Indexed: 05/23/2023]
Abstract
BACKGROUND Ultrasound-guided regional anesthesia (UGRA) is increasingly used by emergency physicians to provide safe and effective pain relief for patients. However, one of the factors limiting its widespread use is the lack of realistic models available for learners to train on. There are currently no inexpensive nerve block models available that are injectable and that closely mimic nerves, fascial planes, muscles, and other landmarks. Our aim is to create inexpensive, injectable nerve block models that can be used as effective medical training tools for UGRA. METHODS By using a lean cut of pork such as pork loin, yarn soaked in ultrasound gel to simulate peripheral nerves, and drinking straws filled with gel to represent vascular structures, we created various nerve block models. Meat glue applied between sections of meat appears hyperechoic under ultrasound, thereby mimicking fascial planes and has the added benefit of helping to secure the components of the model together. Using these elements, we were able to create realistic peripheral nerve, fascia iliaca compartment, serratus anterior plane, and interscalene brachial plexus models. RESULTS One of the necessary skills in performing UGRA involves placing the needle tip along a fascial plane and visualizing hydrodissection of this plane with the local anesthetic. When meat glue (transglutaminase) is applied between layers of meat such as pork loin, the meat binds together and creates a hyperechoic line that mimics a fascial plane. When meat glue is applied to two apposing fascial layers naturally occurring on the meat, the fascial plane can be injected, and fluid can be seen hydrodissecting in this space. We created several nerve block models using meat glue and other components to mimic normal landmarks. CONCLUSIONS We have developed inexpensive and easily reproducible models that create the realistic appearance of tissues, nerves, and fascial planes under ultrasound. They can also accurately simulate hydrodissection of fluid in fascial planes. We hope these nerve block models will allow for the education in UGRA to be more widespread and accessible to learners from all specialties.
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Affiliation(s)
- Leily Naraghi
- Maimonides Medical Center, Department of Emergency Medicine, 4802 10th Ave, Brooklyn, NY 11219 USA
| | - Judy Lin
- Maimonides Medical Center, Department of Emergency Medicine, 4802 10th Ave, Brooklyn, NY 11219 USA
| | - Kay Odashima
- Maimonides Medical Center, Department of Emergency Medicine, 4802 10th Ave, Brooklyn, NY 11219 USA
| | - Simran Buttar
- Maimonides Medical Center, Department of Emergency Medicine, 4802 10th Ave, Brooklyn, NY 11219 USA
| | - Lawrence Haines
- Maimonides Medical Center, Department of Emergency Medicine, 4802 10th Ave, Brooklyn, NY 11219 USA
| | - Eitan Dickman
- Maimonides Medical Center, Department of Emergency Medicine, 4802 10th Ave, Brooklyn, NY 11219 USA
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Li P, Yang Z, Jiang S. Tissue mimicking materials in image-guided needle-based interventions: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 93:1116-1131. [PMID: 30274042 DOI: 10.1016/j.msec.2018.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/25/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
Image-guided interventions are widely employed in clinical medicine, which brings significant revolution in healthcare in recent years. However, it is impossible for medical trainees to experience the image-guided interventions physically in patients due to the lack of certificated skills. Therefore, training phantoms, which are normally tissue mimicking materials, are widely used in medical research, training, and quality assurance. This review focuses on the tissue mimicking materials used in image-guided needle-based interventions. In this case, we need to investigate the microstructure characteristics and mechanical properties (for needle intervention), optical properties and acoustical properties (for imaging) of these training phantoms to compare with the related properties of human real tissues. The widely used base materials, additives and the corresponding concentrations of the training phantoms are summarized from the literatures in recent ten years. The microstructure characteristics, mechanical behavior, optical properties and acoustical properties of the tissue mimicking materials are investigated, accompanied with the common experimental methods, apparatus and theoretical algorithm. The influence of the concentrations of the base materials and additives on these characteristics are compared and classified. In this review, we assess a comprehensive overview of the existing techniques with the main accomplishments, and limitations as well as recommendations for tissue mimicking materials used in image-guided needle-based interventions.
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Affiliation(s)
- Pan Li
- Centre for Advanced Mechanisms and Robotics, School of Mechanical Engineering, Tianjin University, No. 135, Yaguan Road, Jinnan District, Tianjin City 300354, China
| | - Zhiyong Yang
- Centre for Advanced Mechanisms and Robotics, School of Mechanical Engineering, Tianjin University, No. 135, Yaguan Road, Jinnan District, Tianjin City 300354, China
| | - Shan Jiang
- Centre for Advanced Mechanisms and Robotics, School of Mechanical Engineering, Tianjin University, No. 135, Yaguan Road, Jinnan District, Tianjin City 300354, China.
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Aoyagi M, Hiraguri T. Ultrasound Phantom Using Sodium Alginate as a Gelling Agent. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2345-2353. [PMID: 28543374 DOI: 10.1002/jum.14252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/29/2017] [Indexed: 06/07/2023]
Abstract
For medical workers, ultrasound phantoms for human soft tissue are used not only for accuracy management of ultrasound diagnosis but also to aid ultrasound-guided needle and blind catheter insertion training without risk to real patients. For the phantoms, ultrasound characteristics and a texture are required to mimic the human soft tissue. The proposed phantom was composed of sodium alginate, calcium sulfate dihydrate, trisodium phosphate 12-hydrate, glycerol, and water. The propagation speed, attenuation coefficient, acoustic impedance, and texture of the proposed phantom were almost the same as those of human soft tissue. Expensive chemicals and special equipment are not required.
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Affiliation(s)
- Minoru Aoyagi
- Department of Electrical and Electronics Engineering, Nippon Institute of Technology, Saitama, Japan
| | - Tomomi Hiraguri
- Faculty of Health Sciences, Tokoha University, Shizuoka, Japan
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20
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A randomized study of training with large versus small vessel size on successful ultrasound-guided peripheral venous access. J Vasc Access 2017; 18:163-166. [PMID: 28165578 DOI: 10.5301/jva.5000645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Our objective was to investigate whether training on phantoms with smaller or larger vessels would improve success rate in novice medical students learning this skill. METHODS Medical students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral intravenous (IV) catheter. They were then randomized to practice three times on homemade phantom models with either a 5-mm or a 2.5-mm diameter simulated vessel. Afterwards, they were observed attempting to place an ultrasound-guided IV on a 5-mm diameter vessel. Successful cannulation rates was the primary outcome. RESULTS Fifty-one students from five institutions were included in the analysis. No significant difference in success rate, time to cannulation, number of sticks, or number of redirects was seen between the group who trained on the phantoms with the smaller vessels versus those who trained on the phantoms with the larger vessel. A trend towards significance was seen for success rate and number of redirects, favoring the group trained on the smaller vessels, but this did not reach significance. CONCLUSION In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.
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Lahham S, Smith T, Baker J, Purdy A, Frumin E, Winners B, Wilson SP, Gari A, Fox JC. Procedural simulation: medical student preference and value of three task trainers for ultrasound guided regional anesthesia. World J Emerg Med 2017; 8:287-291. [PMID: 29123607 DOI: 10.5847/wjem.j.1920-8642.2017.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks. METHODS This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device. RESULTS Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10 (40%) of the participants preferred the Blue Phantom model, while 10 (40%) preferred the homemade gelatin model and 5 (20%) preferred the homemade tofu model. After cost awareness, the majority, 18 (72%) preferred the gelatin model. CONCLUSION The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.
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Affiliation(s)
- Shadi Lahham
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Taylaur Smith
- UC Irvine School of Medicine, Irvine, California, USA
| | - Jessa Baker
- UC Irvine School of Medicine, Irvine, California, USA
| | - Amanda Purdy
- UC Irvine School of Medicine, Irvine, California, USA
| | - Erica Frumin
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Bret Winners
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Sean P Wilson
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Abdulatif Gari
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - John C Fox
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
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Chen KC, Lin ACM, Chong CF, Wang TL. An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department. J Intensive Care 2016; 4:55. [PMID: 27529031 PMCID: PMC4983782 DOI: 10.1186/s40560-016-0173-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/12/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The skin, soft tissue, and most parts of the musculoskeletal system are relatively superficial anatomical structures and ideal targets for ultrasound examination in the emergency departments. Soft tissue and musculoskeletal ultrasound applications are relatively underused compared to traditional emergency applications, such as trauma, abdominal aortic aneurysm, and chest and cardiovascular systems. MAIN TEXT It is important to have knowledge about sonoanatomy and landmarks within the skin, soft tissue, and musculoskeletal systems. Portable machines equipped with high-resolution transducers are now available to fulfill this field of applications in many emergency departments. After needling practice, emergency physicians can not only diagnose and identify pathological findings but also provide interventional procedures and treatments. In this review, we will introduce point-of-care ultrasound (POCUS) applications regarding the soft tissue and musculoskeletal systems: soft tissue infections, joint effusions, foreign bodies, long bone fractures, muscle and tendon injuries, vascular occlusions, and procedures. CONCLUSIONS With POCUS, emergency physicians can visualize the structures beneath the skin and provide better and safer cares in the emergency departments.
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Affiliation(s)
- Kuo-Chih Chen
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Aming Chor-Ming Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tzong-Luen Wang
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Kim YH. Ultrasound Phantoms to Protect Patients from Novices. Korean J Pain 2016; 29:73-7. [PMID: 27103961 PMCID: PMC4837122 DOI: 10.3344/kjp.2016.29.2.73] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kwon SY, Hong SH, Kim ES, Park HJ, You Y, Kim YH. The Efficacy of Lumbosacral Spine Phantom to Improve Resident Proficiency in Performing Ultrasound-Guided Spinal Procedure. PAIN MEDICINE 2015; 16:2284-91. [DOI: 10.1111/pme.12870] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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An affordable and easily constructed model for training in ultrasound-guided vascular access. J Vasc Access 2015; 16:422-7. [PMID: 26349885 DOI: 10.5301/jva.5000384] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This paper describes a simple and inexpensive method to make high-fidelity simulators for use in ultrasound-guided vascular access teaching. The phantoms can be created to reflect the ultrasound appearance and feel of central or peripheral arteries and veins. Different clinical states such as hypovolaemia may be readily displayed using the phantoms. METHODS The article and associated videos describe the production, appearance and use of phantoms for central vascular access, for peripheral venous access and for peripheral arterial access. Key ingredients are readily accessible and include chicken breasts, modelling balloons and thin walled latex or silicone tubing. RESULTS The phantoms are easily and rapidly constructed and may be used repeatedly in a training session. As the needle passes through the phantom and vessel wall, the ultrasound appearance and tactile sensation is very similar to that of human tissue and vessels. CONCLUSIONS Using this method, simple and inexpensive phantoms can be created. These are ideal for use in training for ultrasound-guided vascular access. Links to videos describing the phantom construction process, their appearance and the teaching techniques utilised by the authors are found in the text.
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Adusumilli P, McCreesh K, Evans T. Development of an anthropomorphic shoulder phantom model that simulates bony anatomy for sonographic measurement of the acromiohumeral distance. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2011-2019. [PMID: 25336490 DOI: 10.7863/ultra.33.11.2011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this project was to create a sonographic phantom model of the shoulder that was accurate in bone configuration. Its main purpose was for operator training to measure the acromiohumeral distance. A computerized 3-dimensional model of the superior half of the humerus and scapula was rendered and 3-dimensionally printed. The bone model was embedded in a gelatin compound and set in a shoulder-shaped mold. The materials used had speeds of sound that were well matched to soft tissue and epiphyseal bone. The model was specifically effective in simulating the acromiohumeral distance because of its accurate bone geometry.
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Affiliation(s)
- Pratik Adusumilli
- University of Leeds, Leeds, England (P.A., T.E.); and University of Limerick, Limerick, Ireland (K.M.).
| | - Karen McCreesh
- University of Leeds, Leeds, England (P.A., T.E.); and University of Limerick, Limerick, Ireland (K.M.)
| | - Tony Evans
- University of Leeds, Leeds, England (P.A., T.E.); and University of Limerick, Limerick, Ireland (K.M.)
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