University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Interventional Radiology Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Acad Radiol. 2018 Nov;25(11):1503-1509. doi: 10.1016/j.acra.2018.05.019. Epub 2018 Jul 17.
Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care.
Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access.
The ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient.
Lightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.
对于医学生和住院医师来说,掌握超声(US)成像和 US 引导下的操作通常具有一定难度。人们强烈鼓励使用模拟训练,但可用于 US 引导下操作的人体模型的质量有限。因此,我们创新性地使用轻度防腐的尸体来模拟常见介入放射学(IR)操作,以便在直接接触患者之前进行真实的实践。
将轻度防腐的尸体放置在 IR 检查室中患者的常规体位:仰卧位、俯卧位和直立坐位。使用标准经皮技术注射利多卡因并进行可视化,模拟在 IR 中进行的常见 US 引导下的操作,包括肝活检、肾活检、胸腔穿刺和血管通路建立。
尸体的定位能力是能够完成整个操作模拟的关键因素。对 US 成像仅有有限接触的医学生和对 US 成像仅有最低限度接触的放射诊断学住院医师成功地完成了常见的 US 引导下的操作。获得了动脉和静脉血管通路。可以通过这些通路传递导丝并轻松放置导管。当受训者推进针或扩张组织时,组织层的质地为他们提供了真实的反馈。每个模拟操作的图像都类似于在活体患者中预期的图像。
轻度防腐的尸体是一种创新且可行的工具,可以在逼真的方式下模拟常见的 IR US 引导下的操作,为首次接触患者之前的首次尝试提供有针对性的实践。