High-Fidelity Simulation Training for the Diagnosis and Management of Adverse Contrast Media Reactions.

OBJECTIVE: Adverse reactions to contrast media are potentially life-threatening events that require prompt recognition and management by radiologists who may have little experience with them. The objectives of this project were to develop and assess a simulation-based program that would equip radiology trainees with appropriate knowledge and skills to recognize and manage adverse contrast media reactions. MATERIALS AND METHODS: Fifteen adverse contrast media reaction scenarios were developed to run on high-fidelity adult and pediatric mannequins in a simulation center. Ninety-six radiology trainees (postgraduate year 2-6) participated in the program, which consisted of two didactic lectures and a simulation session. For each simulation session, seven scenarios were chosen. Objective quizzes assessing knowledge and subjective questionnaires assessing comfort were completed both before and after the simulation. A survey assessing the overall program was also completed. RESULTS: All 96 radiology trainees viewed the didactic lectures, attended a simulation session, and completed the pre- and postsimulation quizzes and questionnaires. Mean scores increased from 69% to 82% (p < 0.001) and from 3.1 to 4.5 out of 5 (p < 0.001) on the objective and subjective tests, respectively. Statistically significant improvement was also seen when participants were separated according to level of training. On the final program evaluation survey, scores ranged from 4.5 to 4.7 out of 5. CONCLUSION: We describe the development of a high-fidelity simulation program with a larger variety of scenarios than in prior studies that can provide radiologists the knowledge and skills needed to recognize and manage adverse contrast media reactions. We saw a statistically significant improvement in knowledge and comfort levels across all levels of training.

Virtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided Lumbar Puncture: A Pilot Study.

RATIONALE AND OBJECTIVES: Fluoroscopy-guided lumbar puncture (FGLP) is a basic procedural component of radiology residency and neuroradiology fellowship training. Performance of the procedure with limited experience is associated with increased patient discomfort as well as increased radiation dose, puncture attempts, and complication rate. Simulation in health care is a developing field that has potential for enhancing procedural training. We demonstrate the design and utility of a virtual reality simulator for performing FGLP. MATERIALS AND METHODS: An FGLP module was developed on an ImmersiveTouch platform, which digitally reproduces the procedural environment with a hologram-like projection. From computed tomography datasets of healthy adult spines, we constructed a 3-D model of the lumbar spine and overlying soft tissues. We assigned different physical characteristics to each tissue type, which the user can experience through haptic feedback while advancing a virtual spinal needle. Virtual fluoroscopy as well as 3-D images can be obtained for procedural planning and guidance. The number of puncture attempts, the distance to the target, the number of fluoroscopic shots, and the approximate radiation dose can be calculated. Preliminary data from users who participated in the simulation were obtained in a postsimulation survey. RESULTS: All users found the simulation to be a realistic replication of the anatomy and procedure and would recommend to a colleague. On a scale of 1-5 (lowest to highest) rating the virtual simulator training overall, the mean score was 4.3 (range 3-5). CONCLUSIONS: We describe the design of a virtual reality simulator for performing FGLP and present the initial experience with this new technique.