Presented at the 2012 AAPM Annual Meeting « Back

A Training System for Sacral Transforaminal, Caudal, and Sacroiliac Joint Injections

Dmitri Souzdalnitski, MD, PhD, dmitrisouz@gmail.com¹, Imanuel R. Lerman, MD, MS², (1) Cleveland Clinic Foundation, Cleveland, Ohio, (2) Massachusetts General Hospital, Boston, Massachusetts

Although new imaging modalities continue to be developed for use in interventional pain management, the ability to master these new imaging modalities takes training and time. This report describes a low-cost, easy-to-prepare combined radiographic and ultrasound phantom. The phantom was prepared from moldable plastic, which is commercially available. The plastic is heated to 325 degrees Fahrenheit and then poured into a box that houses an anthropomorphic sacroiliac joint (SIJ) and sacrum model. Sacral foramina and SIJ are filled with the conducting material that is connected to the recording device. The phantom is then allowed to cool over a 45-minute period. After cooling, the phantom is ready for training practice sessions. After repeated use the model can be heated to erase needle track marks. The SIJ and sacral foramina injection phantom training system accurately simulates human tissue by imitating both the tactile texture of skin and the haptic resistance of human tissue as the needle is advanced. Under fluoroscopic examination the phantom accurately simulates an anthropomorphic image. The trainee experiences positive feedback in the form of illumination and sound when the target is reached, and negative feedback in the form of a timer that will activate a loud beeping noise to indicate that the session has ended. A performance analysis is carried out after two sessions. To our knowledge, this is the first synthetic SIJ and sacral area phantom that allows pain physicians to practice needle positioning technique under both ultrasound and radiographic guidance with positive and negative feedback. References: 1)Narouze, SN, Peng, PWH. Ultrasound-guided interventional procedures in painmedicine: A review of anatomy, sonoanatomy, and procedures: Part ii: Axial structures. Regional Anesthesia & Pain Medicine, 35(4), 386-396. 2)Atallah J. Pain simulator can improve the training of residents and pain fellows in performing pain management procedures. Pain Physician, 2007; 10:511-517. 3)Hutcheson K, McKenzie-Brown K, Hutcheson K, Hanowell D. Simulation for Interventional Pain Procedures – a novel educational tool. Regional Anesthesia Pain Medicine 2007; 32:A-3.

Funding: None