Fun with electricity: A novel ballistics gelatin model with LED tracking for ultrasound needle guidance

Abstract

Background: Use of ultrasound (US) for procedural needle guidance can improve success rates, safety, and accuracy. Often, training is performed on task trainers, which can be prohibitively expensive. Determining undesired needle placement is difficult when the needle is poorly visualized with US. Currently available simulation phantoms cannot provide real-time feedback on the location of needle placement.

Objectives: The primary objective was to develop and determine feasibility of a low-cost simulation phantom with an internal circuit and LED light system to determine when a needle contacts internal structures. We also aimed to determine whether its use was associated with increased comfort level.

Methods: Emergency medicine (EM) residents (PGY-1 to PGY-3) performed in-plane and out-of-plane US needle guidance using homemade phantoms. Comfort levels were assessed by pre- and post intervention survey. Outcomes were measured on Likert scale (minimum = 1, maximum = 5). The primary outcome was change in confidence markers before and after the simulation task. Secondary outcomes were survey results of comparisons of these models to prior training experiences on simulators and humans.

Results: All EM residents (30) in our program were invited to participate. Twenty participants enrolled and completed the study. In the primary outcome, median comfort with out-of-plane and in-plane guidance increased after using the model but was more pronounced for out-of-plane guidance. On a posttest survey, residents rated the models overall very similar to prior experience on simulators (median 5/5 [IQR 4.0-5.0]) and moderately similar to humans (median 3/5 [IQR 3.0-4.0]).

Conclusions: We created a low-cost ballistic gelatin phantom with an internal electric needle guidance system. Use of the phantom for training was associated with increased learner comfort with the procedure. Learners rated the characteristics of the phantom as similar to higher-cost commercial equipment and humans.

FIGURE 1

Image outlining the creation process of the out‐of‐plane (CVC) model. (A) Initial gel pour (base); (B) modeling dough used to simulate carotid artery; (C) second‐stage gel pour covering modeling dough and latex tubing containing olive oil; (D) third‐stage gel pour/completed product.

FIGURE 2

Image outlining the creation process of the in‐plane (nerve block) model. (A) Initial layer of modeling dough used to simulate nerves; (B) second‐stage gel pour covering nerve layer, modeling dough containing hazards in needle path laying on top.

FIGURE 3

Circuit diagram for LED circuit used for the model.