Lumbar Puncture: Creation and Resident Acceptance of a Low-Cost, Durable, Reusable Fluoroscopic Phantom with a Fluid-Filled Spinal Canal for Training at an Academic Program

Abstract

Simulation-based medical training provides learners a method to develop technical skills without exposing patients to harm. Although fluoroscopic phantoms are already adopted in some areas of radiology, this has historically not been for lumbar puncture. Commercially available phantoms are expensive. We report a cost-effective, accessible solution by creation of an inexpensive phantom for resident training to perform fluoroscopically guided lumbar puncture, as well as instructions on how to make a phantom for residency education. An anthropomorphic ballistics-gel phantom that contains a plastic lumbar vertebral column and simulated CSF space was created. Radiology residents with minimum or no experience with fluoroscopically guided lumbar punctures were given a brief education and practiced fluoroscopically guided lumbar punctures on the phantom. A survey from the residents was then done. The phantom was qualitatively quite durable and deemed adequate for educational purposes. All the residents surveyed expressed the desire to have this phantom available and it increased comfort, knowledge, and perceived likelihood of success. Few articles have been published that focused on low-cost phantom creation for fluoroscopic-procedure training. This study supports the benefits of using phantoms for fluoroscopic training as well as step-by-step instructions for creation of this phantom. The residents responded positively and felt more confident in their fluoroscopically guided techniques. The ability to make a long-term training device for resident education would be inexpensive and relatively easy to implement in academic programs.

State‐of‐the‐art of lumbar puncture and its place in the journey of patients with Alzheimer's disease

“…Training can be improved by leveraging video-based or simulationbased training (using either phantoms 87 or virtual-reality devices), which are increasingly being evaluated and adopted in adult neurology settings. [72][73][74][75][76][88][89][90][91][92][93] Studies have consistently found that such training aids are effective and can improve operator confidence, an important finding considering that medical students or junior doctors often report a lack of confidence in performing the procedure, 94,95 and operator stress has been associated with reduced patient confidence in the operator and an increased risk of post-LP headache in patients. 96 Evidence that these benefits can translate into improved performance in clinical practice comes from a study involving 110 junior doctors with no previous experience performing LPs.…”

“…Traditionally, physicians have learned to perform LP through unstructured observation and supervision during medical training. Training can be improved by leveraging video‐based or simulation‐based training (using either phantoms 87 or virtual‐reality devices), which are increasingly being evaluated and adopted in adult neurology settings 72–76,88–93 . Studies have consistently found that such training aids are effective and can improve operator confidence, an important finding considering that medical students or junior doctors often report a lack of confidence in performing the procedure, 94,95 and operator stress has been associated with reduced patient confidence in the operator and an increased risk of post‐LP headache in patients 96 .…”

Assessment and selection of filler compounds for radiopaque PolyJet multi-material 3D printing for use in clinical settings

“…14,15,20 The multi-material feature can allow regions of varying radiopacity, improving the realism of anatomical models when X-ray imaged. 3D printed anatomical models are used for simulating procedures under fluoroscopy, for example lumbar puncture, 21 cardiac catheterisation 22 or screw placement. 23 These simulators could be further improved by introducing radiopaque resin for multi-material 3D printing.…”