Computerized Training for Ultrasound-Guided Lumbar Punctures

A randomized controlled trial was carried out to determine whether Perk Tutor, a computerized training platform that displays an ultrasound image and real-time needle position in a three-dimensional (3D) anatomical model, would benefit residents learning ultrasound-guided lumbar puncture (LP) in simulation phantoms with abnormal spinal anatomy.

Twenty-four residents were randomly assigned to either the Perk Tutor (P) or the Control (C) group and asked to perform an LP with ultrasound guidance on part-task trainers with spinal pathology. Group P was trained with the 3D display along with conventional ultrasound imaging, while Group C used conventional ultrasound only. Both groups were then tested solely with conventional ultrasound guidance on an abnormal spinal model not previously seen. We measured potential tissue damage, needle path in tissue, total procedure time, and needle insertion time. Procedural success rate was a secondary outcome.

The needle tracking measurements (expressed as median [interquartile range; IQR]) in Group P vs Group C revealed less potential tissue damage (39.7 [21.3-42.7] cm2 vs 128.3 [50.3-208.2] cm2, respectively; difference 88.6; 95% confidence intervals [CI] 24.8 to 193.5; P = 0.01), a shorter needle path inside the tissue (426.0 [164.9-571.6] mm vs 629.7 [306.4-2,879.1] mm, respectively; difference 223.7; 95% CI 76.3 to 1,859.9; P = 0.02), and lower needle insertion time (30.3 [14.0-51.0] sec vs 59.1 [26.0-136.2] sec, respectively; difference 28.8; 95% CI 2.2 to 134.0; P = 0.05). Total procedure time and overall success rates between groups did not differ.

Residents trained with augmented reality 3D visualization had better performance metrics on ultrasound-guided LP in pathological spine models.

Related Publications

Yeo, C. T., Davison C., Ungi T., Holden M. S., Fichtinger G., & McGraw R. C. (2015). Examination of learning trajectories for simulated lumbar puncture training using hand motion analysis. Academic Emergency Medicine. 22, 1187-1195.

Keri, Z., Sydor D., Ungi T., Holden M. S., McGraw R. C., Mousavi P., et al. (2015). Computerized training system for ultrasound-guided lumbar puncture on abnormal spine models: a randomized controlled trial. Canadian Journal of Anesthesia. 62, 777-784.

Clinkard, D., Moult E., Holden M. S., Davison C., Ungi T., Fichtinger G., et al. (2015). Assessment of Lumbar Puncture Skill in Experts and Nonexperts Using Checklists and Quantitative Tracking of Needle Trajectories: Implications for Competency-Based Medical Education. Teaching and Learning in Medicine. 27, 51-56.