Training of CT-guided Periradicular Therapy in a Realistic Simulation Environment - Evaluation and Recommendations for a Training Curriculum.

RATIONALE AND OBJECTIVES: To evaluate the training of computed tomography (CT)-guided periradicular therapy in a realistic simulation environment and to derive recommendations for a training curriculum. MATERIALS AND METHODS: A novel simulation environment including the use of a 3D printed, patient-mimicking phantom was used to train medical students to perform CT-guided periradicular therapy of the lumbar spine. Seventeen participants underwent three training sessions (day 0, day 7, and after day 28) with six procedures per session. Procedure duration and the number of fluoroscopy image acquisitions were recorded. Participants' performance was assessed by an independent investigator using a six-point checklist scale (0 = lowest, 6 = highest). In addition, participants self-evaluated their skills and the simulation training in questionnaires. RESULTS: Procedure durations and image acquisitions decreased after one training session (p < 0.001) without further improvement thereafter (p > 0.6). They also decreased within training sessions and were lowest after five procedures in all sessions. Performance scores improved after the first session to nearly perfect scores in the second session (mean 5.7; 95%CI: 5.5-6.0; p < 0.001) and decreased again in the third session (mean 4.9; 95%CI: 4.6-5.3; p = 0.008). Participants were satisfied with their training progress and felt adequately prepared to perform CT-guided periradicular therapies on patients after the training. CONCLUSION: Simulation-based training of CT-guided periradicular therapy in a realistic environment is effective and should ideally be performed with one training session consisting of five procedures shortly before treating the first patient.

Scout-guided needle placement-a technical approach for dose reduction in CT-guided periradicular infiltration.

PURPOSE: To develop and evaluate a technical approach for CT-guided periradicular infiltration using quantitative needle access and guidance parameters extracted from CT scout images. METHODS: Five 3D-printed phantoms of the abdomen mimicking different patients were used to develop a technical approach for scout-guided periradicular infiltration. The needle access point, puncture depth, and needle angulation were calculated using measurements extracted from anterior-posterior and lateral CT scout images. Fifty needle placements were performed with the technique thus developed. Dose exposure and number of image acquisitions were compared with ten procedures performed using a conventional free-hand technique. Data were analyzed with the Mann-Whitney U test. RESULTS: Parameters derived solely from scout images provided adequate guidance for successful and reliable needle placement. Needle guidance was performed with the same equipment as the standard periradicular infiltration. Two scout images and 3.5 ± 2.3 (mean ± SD) single-shot images for needle positioning were acquired. Mean DLP ± SD was 3.8 ± 2.5 mGy cm. The number of single-shot acquisitions was reduced by 68% and the overall dose was reduced by 84% in comparison with the conventional free-hand technique (p < 0.0001). CONCLUSION: Scout-guided needle placement for periradicular infiltration is feasible and reduces radiation exposure significantly.