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

Patient-Specific Highly Realistic Spine Surgery Phantom Trainers

A realistic phantom created from a three-dimensional (3D)-reconstructed digital patient model would enable researchers to investigate the morphological aspects of the pathological spine, thereby resolving the issue of scarce cadaveric specimens. We designed a patient-specific, human-like, reliable, and cost-effective prototype of the examined pathological spine through open-source editing software analysis, a desktop 3D printer, and alginate material. We aimed to validate that the major surgical steps and anatomy replicated the real surgery as it would be conducted in actual patients.We cover the fundamental principles and procedures involved in 3D printing, from spine imaging to phantom manufacturing. Three representative simulation cases were included in the study. All phantoms were sequentially evaluated by surgeons for fidelity. Following each surgery, participants were given a survey that included 20 questions regarding the fidelity of the training phantom.We validated this simulation model by analyzing neurosurgeons' performance on the phantom trainer. Based on a 20-item survey to test content validity and reliability, there was little variation among participants' ratings, and the feedback was consistently positive. The gross appearance of the phantom was analogous to the cadaveric specimen and the phantoms demonstrated an excellent ability to imitate the intraoperative condition. The plastic material expenditure ranged from 170 to 470 g, and the alginate expenditure was 450 g. The total cost of acrylonitrile butadiene styrene (ABS) varied from $5.1 to $17.6 ($0.03 per gram of ABS), whereas the total cost of alginate was $14.3. The average cost of our phantoms was approximately $25.7, and the 3D printer used in this study costs approximately $200.The basic properties of this phantom were similar to cadaveric tissue during manipulation. We believe our phantoms have the potential to improve skills and minimize risk for patients when integrated into trainee education.

Enhancing Access to Neuraxial Ultrasound Phantoms for Medical Education of Pediatric Anesthesia Trainees: Tutorial

Unlabelled

Opportunities to learn ultrasound-guided/assisted (USGA) neuraxial techniques for pediatric patients are limited, given the inherent high stakes and small margin of error in this population. Simulation is especially valuable in pediatrics because it enhances competency and efficiency, without added risk, when learning new skills, specifically those seen with ultrasound-guided regional anesthetic techniques. However, access to simulation opportunities involving the use of phantom models in medical education is limited due to excessive costs. We describe a process for producing ultrasound phantoms by using synthetic ballistic gelatin; these ultrasound phantoms can be used for simulation and are affordable, reproducible, and indefinitely shelf stable. The ultrasound images produced by these phantoms are comparable to those obtained from a real pediatric patient, including the sacral anatomy necessary for caudal epidural blocks, as validated by practicing pediatric anesthesiologists. Phantom models offer a more cost-effective alternative to commercially prepared phantoms, thereby expanding access to realistic simulations for neuraxial ultrasound in pediatric medical education, without the prohibitively high expense.

Discriminative Ability of Dye Injected Into a Meat Model to Determine Accuracy of Ultrasound-Guided Injection

INTRODUCTION

The utility of using meat models for ultrasound-guided regional anesthesia simulation training has been well established. Feedback is considered the most important element of successful simulation-based education, and simulation offers an opportunity for evaluation. The objective of this study was to establish the discriminative ability of dye injected into a meat model to determine whether injectate is properly placed in the perineural (PN) space, thus providing an additional tool for learner feedback and evaluation.

METHODS

Meat models containing a beef tendon (simulating a nerve) were injected with dye in one of 3 locations: PN, intraneural, and intramuscular. Blinded assessors then independently interpreted the dye staining on the models, marked the interpreted injection location, ease of interpretation, and whether staining was present on the beef tendon.

RESULTS

Thirty meat models were injected with dye and independently assessed. Determining the location of injection was deemed to be easy or very easy in 72% of the models. Assessors correctly identified PN, intraneural, and intramuscular injections 100%, 95%, and 85% of the time, respectively. Assessor agreement was 87%.

CONCLUSIONS

The location of dye injected into a meat model, simulating a peripheral nerve blockade, can be accurately and reliably scored to provide feedback to learners. This technique offers a novel means of providing feedback to trainees and assessing block success in ultrasound-guided regional anesthesia simulation.

Emerging Biomedical and Clinical Applications of 3D-Printed Poly(Lactic Acid)-Based Devices and Delivery Systems

Poly(lactic acid) (PLA) is widely used in the field of medicine due to its biocompatibility, versatility, and cost-effectiveness. Three-dimensional (3D) printing or the systematic deposition of PLA in layers has enabled the fabrication of customized scaffolds for various biomedical and clinical applications. In tissue engineering and regenerative medicine, 3D-printed PLA has been mostly used to generate bone tissue scaffolds, typically in combination with different polymers and ceramics. PLA's versatility has also allowed the development of drug-eluting constructs for the controlled release of various agents, such as antibiotics, antivirals, anti-hypertensives, chemotherapeutics, hormones, and vitamins. Additionally, 3D-printed PLA has recently been used to develop diagnostic electrodes, prostheses, orthoses, surgical instruments, and radiotherapy devices. PLA has provided a cost-effective, accessible, and safer means of improving patient care through surgical and dosimetry guides, as well as enhancing medical education through training models and simulators. Overall, the widespread use of 3D-printed PLA in biomedical and clinical settings is expected to persistently stimulate biomedical innovation and revolutionize patient care and healthcare delivery.

SimuVet: a preliminary study of the innovative development of a simulator for epidural anesthesia training in dogs

Epidural anesthesia in dogs is a locoregional anesthesia technique used in veterinary medicine, becoming an important integrated application in the anesthetic protocol to provide safer and more effective analgesia to patients. For this, professionals must adhere to rigorous guidelines and possess technical skills. In this context, in veterinary education, the development of practical clinical skills represents a crucial aspect in the training of these professionals. However, traditional teaching methods have proven insufficient to ensure a consistent level of competence among recent graduates. The introduction of non-animal alternatives for educational purposes has contributed to the development of simulation-based teaching, an innovative and accessible field capable of enhancing pre-clinical proficiency in students and reducing the use of live animals and cadavers. Despite its application in various areas of veterinary education, there are no conclusive results regarding the development of accessible simulators capable of effectively enhancing training in epidural anesthesia in dogs. Therefore, this article represents a pioneering study aimed at sharing a method for creating SimuVet, a realistic simulator for training epidural anesthesia in dogs. The simulator was fully developed by veterinary researchers with limited experience in 3D printing and, after preliminary analysis, demonstrated excellent performance and ultrasonographic anatomy. Future work will focus on the formal validation of this simulator with the aim of improving the teaching and learning process for students and experts in performing epidural anesthesia in companion animals.

Development and Evaluation of An In-House Lumbar Puncture Simulator for First-Year Resident Lumbar Puncture Procedure Learning

INTRODUCTION

Lumbar puncture (LP) is a common invasive technique considered an essential learning milestone for anesthesiologists due to its application in spinal anesthesia. We aimed to develop an in-house LP simulator, test its effectiveness in learning the steps to perform an LP and analyze its impact on the first-year residents' self-confidence at our hospital.

METHODS

 We used 3D printing and silicone casting to create an LP simulator based on a lumbar spine computed tomography (CT). We divided 12 first-year anesthesiology residents into control and experimental groups. The control group received traditional training, while the experimental group practiced with the simulator for three months. We used a procedure checklist and a Likert scale survey to evaluate their procedural knowledge and self-confidence at baseline, three, and six months. Eighteen months later, we evaluated their LP performance skills.

RESULTS

Both groups showed a significant improvement in their knowledge scores over time. After three months, the experimental group had a higher median knowledge score (10 (10 - 10) median (min-max)) than the control group (9 (8 - 9.5) median (min-max)) (p = 0.03). While there were no apparent differences in median self-confidence scores between the groups at any time point, the experimental group had a significant increase in their self-confidence for performing an unassisted LP, with a median score of 1/5 (1 - 2.3) at baseline and 5/5 (4.8 - 5) after six months (p = 0.006). In contrast, the control group's self-confidence scores decreased from 4/5 (3 - 4) after three months to 3/5 (2 - 5) after six months. The evaluation of performance skills did not yield statistically significant results.

CONCLUSION

Our study demonstrates that an in-house LP simulator is an effective and practical approach for first-year anesthesiology residents to learn the LP procedure. This approach could be particularly useful in settings with limited resources and a lack of sufficient patients to practice on, as it provides an opportunity for faster learning and increased self-confidence.

Boosting Confidence: Enhancing Spinal Cord Stimulator Needle and Lead Placement Through Simulation Training

Background This pilot study aims to examine the effectiveness of a spinal cord stimulator (SCS) simulator training system in improving the confidence of pain fellows in SCS placement. Methodology Five Ukrainian physicians (neurologists, neurosurgeons, and an anesthesiologist) completed a 10-item survey regarding their confidence in various aspects of SCS placement and their opinions on how effective SCS models were for educational purposes. After placing SCS leads using the SCS simulator, the physicians took the same survey again. The Mann-Whitney U test was used to determine if there was a significant difference in total scores pre and post-simulator training. The software PAST (PAleontological STatistics) was used for statistical analysis. Results Overall, five participants had a 38% statistically significant increase in survey scores before and after the intervention (mean: 4.2 vs. 6.2, p = 0.0055). With regards to each item of the survey, participants had a significantly increased confidence in driving leads (2.6 vs. 5.2, p = 0.008) and in overall technical skills for the SCS procedure after the training (2.8 vs. 5.2, p = 0.0188). Although the other eight survey items were not statistically significant (p > 0.05), participants had a 28% increase in confidence when inserting epidural needles, a 20% increase in interpreting simulated X-rays, a 32% increase in navigating challenging anatomical variations, a 12% increase in identifying key anatomical landmarks, a 20% increase in ensuring the correct placement of the lead, or a 53% increase in preparedness for performing an SCS procedure in a real clinical setting. The participant's perspective on how valuable the stimulator training was for enhancing procedural skills increased by 38% and how well the simulator replicated real-life SCS procedure increased by 52%, although both were statistically insignificant (p > 0.05). Conclusions This pilot study shows that the utilization of simulated neuromodulation training is a viable means of augmenting neuromodulation education by increasing physician's confidence in aspects of the SCS placement procedure. The extent to which simulator training improves procedural skills in a real-life SCS placement needs to be investigated further.

Development and Validation of a Hybrid Bronchoscopy Trainer Using Three-Dimensional Printing

INTRODUCTION

Simulation is an essential component of medical education. Commercially available intubation simulators often lack anatomical fidelity of the lower airway and are therefore not suitable for teaching bronchoscopy or lung isolation. By using a desktop 3-dimensional (3D) printer, we aimed to create and validate a hybrid simulator from an existing mannequin with a 3D-printed lower airway that has anatomical fidelity and is financially affordable compared with commercially available models.

METHODS

Using an anonymized computed tomography scan of an adult male patient, we developed a 3D model of the airway from below the larynx to the 3rd generation bronchi, which was then printed on a desktop 3D printer. The printed airway was attached to an existing mannequin below the larynx via a universal adaptor. Ten anesthesiology attendings performed a blinded comparison of the hybrid mannequin with a commercially available mannequin for tactile and visual fidelity when performing intubation, bronchoscopy, and lung isolation. They were also asked to assess the models for educational suitability.

RESULTS

The 3D printed model was judged more suitable for teaching double-lumen tube insertion to novice physicians compared with the commercial model, with median (interquartile range) scores of 5 (4-5) versus 3 (2-4), P = 0.017. Similar results were found for bronchial blocker insertion and bronchoscopy. The visual fidelity of the bronchial anatomy was scored as 5 (4-5) and 2 (1-3) for the 3D-printed and the commercial models, respectively ( P = 0.007).

CONCLUSION

By creating a hybrid model combining an existing commercially available mannequin with a 3D-printed trachea and bronchial tree, we have created an affordable training simulator suitable for teaching lung isolation and bronchoscopy. Enhancing existing mannequins with 3D-printed parts may be of particular interest to institutions that do not have the funds to buy models with anatomical fidelity but do have access to a 3D printer.

A Review of Low-Cost Ultrasound Compatible Phantoms

Ultrasound-compatible phantoms are used to develop novel US-based systems and train simulated medical interventions. The price difference between lab-made and commercially available ultrasound-compatible phantoms lead to the publication of many papers categorized as low-cost in the literature. The aim of this review was to improve the phantom selection process by summarizing the pertinent literature. We compiled papers on US-compatible spine, prostate, vascular, breast, kidney, and li ver phantoms. We reviewed papers for cost and accessibility, providing an overview of the materials, construction time, shelf life, needle insertion limits, and manufacturing and evaluation methods. This information was summarized by anatomy. The clinical application associated with each phantom was also reported for those interested in a particular intervention. Techniques and common practices for building low-cost phantoms were provided. Overall, this article aims to summarize a breadth of ultrasound-compatible phantom research to enable informed phantom methods selection.

Computed Tomography Attenuation of Three-Dimensional (3D) Printing Materials-Depository to Aid in Constructing 3D-Printed Phantoms

Three-dimensionally printed phantoms are increasingly used in medical imaging and research due to their cost-effectiveness and customizability, offering valuable alternatives to commercial phantoms. The purpose of this study was to assess the computed tomography (CT) attenuation characteristics of 27 resin materials from Formlabs, a 3D printing equipment and materials manufacturer. Cube phantoms (both solid and hollow constructions) produced with each resin were subjected to CT scanning under varying tube current-time products with attenuation measurements recorded in Hounsfield units (HU). The resins exhibited a wide range of attenuation values (-3.33 to 2666.27 HU), closely mimicking a range of human tissues, from fluids to dense bone structures. The resins also demonstrated consistent attenuation regardless of changes in the tube current. The CT attenuation analysis of FormLabs resins produced an archive of radiological imaging characteristics of photopolymers that can be utilized to construct more accurate tissue mimicking medical phantoms and improve the evaluation of imaging device performance.

Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer

OBJECTIVE

Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time.

METHODS

Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded.

RESULTS

The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate.

CONCLUSIONS

It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.

Design-Based Bone Marrow Biopsy Training

INTRODUCTION

Hematology/oncology fellows must achieve bone marrow biopsy proficiency. However, opportunities for fellows to perform bone marrow biopsies on patients are highly dependent on clinical volume. An easily accessible and feasible system to practice these procedures repetitively has not been described. Other specialties use 3-dimensional (3D)-printed models to practice procedures, but hematology/oncology has not yet incorporated this novel medical education tool, which has the potential to provide such an accessible and feasible system for procedural practice.

METHODS

We used design thinking to develop and pilot a bone marrow biopsy simulation using 3D-printed pelvis models. We printed and optimized 2 models through iterative prototyping. In July 2019, we conducted a 1-hour session with 9 fellows. After an anatomy review, fellows practiced biopsies using the models with faculty feedback. To evaluate feasibility, we reviewed session evaluations, measured fellow comfort, surveyed supervising attendings, and gathered fellow and attending feedback.

RESULTS

Fellows rated the 3D session highly. Fellow comfort improved after orientation. Supervisors noted no difference between the 2019 fellows and prior years. Fellows praised the opportunity to rehearse mechanics, receive feedback, and internalize anatomy. Fellows suggested incorporating a female pelvis and more soft tissue. Attending feedback on the model aligned with fellow feedback. We implemented the session again in 2020 with adjustments based on feedback.

CONCLUSIONS

Three-dimensional printing represents an accessible and feasible educational tool. Three-dimensional-printed models provide opportunities for iterative practice, feedback, and anatomy visualization. Future iterations should continue to incorporate user feedback to optimize model utility.

Use of 3D Printing Technology to Create a Canine Simulator for Cerebrospinal Fluid Sampling at the Lumbar Subarachnoid Space

Cerebrospinal fluid (CSF) sampling at the lumbar subarachnoid space (LSS) is technically challenging to learn. Currently, training relies on cadaver availability or performance in a clinical scenario. This study aims to develop and validate a low-cost, high-fidelity simulator to train in this technique. Using three-dimensional printing technology, a model of a healthy adult dog's lumbosacral vertebral column was produced. The model was augmented with synthetic materials and a fluidic system to replicate all procedural steps and permit successful CSF collection. The simulator was validated by four experts, who rated it highly across multiple criteria. Final-year veterinary students were recruited to take part in practical sessions using either the simulator (n = 16) or a cadaver (n = 16). Performance was recorded for each student, and feedback was obtained using an anonymous online survey. Student performance was similar between groups (p = .2), with 87.5% and 68.75% of students in the simulator and cadaver group, respectively, successfully placing the needle into the LSS. All successful students in the simulator group were able to obtain a CSF sample, versus none in the cadaver group. No difference in the number of attempts was detected between groups (p > .99), with most students taking more than three attempts. User experience was similar between groups, with 93.8% of students in each group rating the session as a positive learning experience. In summary, we demonstrate the validity of a novel, low-cost, and anatomically precise simulator that can be used for teaching CSF sampling at the LSS.

Development of a Head-Mounted Holographic Needle Guidance System for Enhanced Ultrasound-Guided Neuraxial Anesthesia: System Development and Observational Evaluation (Preprint)

Background

Objective

Methods

Results

Conclusions

Trial Registration

Creation of a three-dimensional printed spine model for training in pain procedures

OBJECTIVE

Technological developments have made it possible to create simulation models to educate clinicians on surgical techniques and patient preparation. In this study, we created an inexpensive lumbar spine phantom using patient data and analyzed its usefulness in clinical education.

METHODS

This randomized comparative study used computed tomography and magnetic resonance imaging data from a single patient to print a three-dimensional (3D) bone framework and create a mold. The printed bones and structures made from the mold were placed in a simulation model that was used to train residents. The residents were divided into two groups: Group L, which received only an audiovisual lecture, and Group P, which received an additional 1 hour of training using the 3D phantom. The performance of both groups was evaluated using pretest and post-test analyses.

RESULTS

Both the checklist and global rating scores increased after training in both groups. However, some variables improved significantly only in Group P. The overall satisfaction score was also higher in Group P than in Group L.

CONCLUSIONS

We have described a method by which medical doctors can create a spine simulation phantom and have demonstrated its efficiency for procedural education.

Modeling the basic behaviors of Anesthesia Training in Relation to Puncture and Penetration Feedback

Failure rates in spinal anesthesia are generally low in experienced hands. However, studies report a failure rate variation of 1% to 17% in this procedure. The aim of this study is to bring the main characteristics of in vivo procedure to the virtual reality simulated environment. The first step is to model the behavior of tissue layers being punctured by a needle to then make its inclusion in medical training possible. The simulation proposed here is implemented using a Phantom Omni haptic device. Every crucial sensation of the method mentioned here was assessed by a dozen volunteers who participated in two experiments designed to validate the modeled response. Each user answered six questions (three for each experiment). Good results were achieved in certain essential aspects of the process, such as identifying the number of layers, the most rigid layer to puncture, and the most resistant layers to pass through. These results indicated that it is possible to represent many typical behaviors through virtual needle insertion in spinal anesthesia with the correct use of haptic properties.Clinical relevance- The idea is to create a spinal anesthesia simulator that could work as a complementary step in training new anesthetists. The use of a simulator avoids introducing the first puncture haptic sensation directly in patients.

Applications of 3D printing in critical care medicine: A scoping review

Although a wide range of medical applications for three-dimensional printing technology have been recognised, little has been described about its utility in critical care medicine. The aim of this review was to identify three-dimensional printing applications related to critical care practice. A scoping review of the literature was conducted via a systematic search of three databases. A priori specified themes included airway management, procedural support, and simulation and medical education. The search identified 1544 articles, of which 65 were included. Ranging across many applications, most were published since 2016 in non - critical care discipline-specific journals. Most studies related to the application of three-dimensional printed models of simulation and reported good fidelity; however, several studies reported that the models poorly represented human tissue characteristics. Randomised controlled trials found some models were equivalent to commercial airway-related skills trainers. Several studies relating to the use of three-dimensional printing model simulations for spinal and neuraxial procedures reported a high degree of realism, including ultrasonography applications three-dimensional printing technologies. This scoping review identified several novel applications for three-dimensional printing in critical care medicine. Three-dimensional printing technologies have been under-utilised in critical care and provide opportunities for future research.

Printability assessment of psyllium husk (isabgol)/gelatin blends using rheological and mechanical properties

The primary goal of this study is to highlight the rheological and mechanical properties of a new blend composed of naturally-derived hydrogel materials- psyllium husk (PH) and gelatin (G) for its potential use in three-dimensional (3D) printing technology. The mixtures were prepared at various weight ratios of 100PH, 75PH + 25G and 50PH + 50G. A suitable selection of the printable ink was made based on the preliminary screening steps of manual filament drop test and layer stacking by 3D printing. Printing of the common features such as hexagon and square grids helped evaluating shape fidelity of the chosen ink. Although 50PH + 50G blend was found meeting most of the criteria for an ideal 3D printable ink, rheological and mechanical characterizations have been performed for all the ratios of polymeric blends. This study documents the correlation between various factors of rheology that should be taken into account while categorizing any biomaterial as a printable ink. Yield stress was measured as 18.59 ± 4.21 Pa, 268.74 ± 13.56 Pa and 109.16 ± 9.85 Pa for 50PH + 50G, 75PH + 25G and 100PH, respectively. Similarly, consistency index (K) and flow index (n) were calculated using the power law equation and found as 49.303 ± 4.17, 530.59 ± 10.92, 291.82 ± 10.53 and 0.275 ± 0.04, 0.05 ± 0.005, 0.284 ± 0.04 for 50PH + 50G, 75PH + 25G and 100PH, respectively. The loss modulus (G″) was observed dominating over storage modulus (G') for 50PH + 50G, that depicts its liquid-like property; whereas storage modulus (G') was found dominating in case of 75PH + 25G and 100PH, indicating their solid-like characteristics. In addition, the loss tangent value (tan δ) of 50PH + 50G was observed exceeding unity (1.05), supporting its plastic behavior, unlike 75PH + 25G (0.5) and 100PH (0.33) whose loss tangent values were estimated less than unity revealing their elastic behavior. Also, 50PH + 50G was found to have the highest mechanical strength amongst the three blends with a Young's modulus of 9.170 ± 0.0881 kPa.

Use of three-dimensional printing for simulation in ultrasound education: a scoping review

Background

There is a significant learning curve when teaching ultrasonography to medical trainees; task trainers can help learners to bridge this gap and develop their skills. Three-dimensional printing technology has the potential to be a great tool in the development of such simulators.

Objective

This scoping review aimed to identify what 3D-printed models have been used in ultrasound education to date, how they were created and the pros and limitations involved.

Design

Researchers searched three online databases to identify 3D-printed ultrasound models used in medical education.

Results

Twelve suitable publications were identified for inclusion in this review. The models from included articles simulated largely low frequency and/or high stakes events, with many models simulating needle guidance procedures. Most models were created by using patient imaging data and a computer-aided design software to print structures directly or print casting molds. The benefits of 3D-printed educational trainers are their low cost, reproducibility, patient specificity and accuracy. The current limitations of this technology are upfront investments and a lack of optimisation of materials.

Conclusions

The use of 3D-printed ultrasound task trainers is in its infancy, and more research is needed to determine whether or not this technology will benefit medical learners in the future.

Evaluation of a Patient-Specific, Low-Cost, 3-Dimensional-Printed Transesophageal Echocardiography Human Heart Phantom

OBJECTIVE

Currently available 3-dimensional (3D) modeling and printing techniques allow for the creation of patient-specific models based on 3D medical imaging data. The authors hypothesized that a low-cost, patient-specific, cardiac computed tomography-based phantom, created using desktop 3D printing and casting, would have comparable image quality, accuracy, and usability to an existing commercially available echocardiographic phantom.

DESIGN

Blinded comparative study.

SETTING

Simulation laboratory at a single academic institution.

PARTICIPANTS

Voluntary cardiac anesthesiologists at a single academic institution.

INTERVENTIONS

Stage 1 of the study consisted of an online questionnaire in which a set of basic transesophageal echocardiography (TEE) views obtained from the 3D printed phantom and commercial phantom were presented to participants, who had to identify the views and evaluate their fidelity to clinical images on a Likert scale. In stage 2, participants performed an unblinded basic TEE examination on both phantoms.

MEASUREMENTS AND MAIN RESULTS

The time needed to acquire each basic view was recorded. Overall usability of the phantoms was assessed through a questionnaire. The participants could recognize most of the views. Fidelity ratings for both phantoms were similar (p < 0.05), with the exception of a midesophageal 2-chamber view that was observed better on the 3D printed phantom. The time required to obtain the views was shorter for the 3D printed phantom, although not statistically significant for most views. The overall user experience was better for the 3D phantom for all categories examined (p < 0.05).

CONCLUSIONS

The study suggested that a 3D-printed TEE phantom is comparable with the commercially available one with good usability.

A do-it-yourself 3D-printed thoracic spine model for anesthesia resident simulation

Central line placement, cricothyroidotomy, and lumbar epidural placement are common procedures for which there are simulators to help trainees learn the procedures. However, a model or a simulator for thoracic epidurals is not commonly used by anesthesia training programs to help teach the procedure. This brief technical report aims to share the design and fabrication process of a low-cost and do-it-yourself (DIY) 3D-printed thoracic spine model. Ten expert anesthesiology attendings and fifteen novice anesthesiology residents practiced with the model and were subsequently surveyed to assess their attitudes towards its fidelity and usefulness as a teaching tool. Responses were recorded with a Likert scale and found to be positive for both groups. Design files and an assembly manual were developed and made public through an open-source website.

Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology

Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.

Construction of an Affordable Lumbar Neuraxial Block Model Using 3D Printed Materials

Access to affordable 3D printing technology has resulted in increased interest in the creation of medical phantom task trainers. Recent research has validated the use of these trainers in simulation education. However, task trainers remain expensive, limiting their availability to medical training programs. We describe the construction of a low-cost task trainer using fused filament fabrication (FFF) printed spinal vertebrae placed in a synthetic gelatin matrix. Additionally, our model contains a realistic simulated ligamentum flavum, a removable silicone skin, as well as spinal fluid reservoir that provides a positive endpoint for intrathecal blocks. The total cost of this model was less than $400 USD. The time to 3D print the bony anatomic parts was approximately 26 hours. While we have not formally validated our model, initial impressions of tactile feel and realism were deemed positive by experienced anesthesia providers. Future work will focus on continued refinement of the model features and construction.