title: Simulation-based educational curriculum for fluoroscopically guided lumbar puncture improves operator confidence and reduces patient dose.
abstract: OBJECTIVE
  Fluoroscopically guided lumbar puncture (FGLP) is a commonly performed procedure with increased success rates relative to bedside technique. However, FGLP also exposes both patient and staff to ionizing radiation. The purpose of this study was to determine if the use of a simulation-based FGLP training program using an original, inexpensive lumbar spine phantom could improve operator confidence and efficiency, while also reducing patient dose.
  
  
  METHODS
  A didactic and simulation-based FGLP curriculum was designed, including a 1-hour lecture and hands-on training with a lumbar spine phantom prototype developed at our institution. Six incoming post-graduate year 2 (PGY-2) radiology residents completed a short survey before taking the course, and each resident practiced 20 simulated FGLPs using the phantom before their first clinical procedure. Data from the 114 lumbar punctures (LPs) performed by the six trained residents (prospective cohort) were compared to data from 514 LPs performed by 17 residents who did not receive simulation-based training (retrospective cohort). Fluoroscopy time (FT), FGLP success rate, and indication were compared.
  
  
  RESULTS
  There was a statistically significant reduction in average FT for the 114 procedures performed by the prospective study cohort compared to the 514 procedures performed by the retrospective cohort. This held true for all procedures in aggregate, LPs for myelography, and all procedures performed for a diagnostic indication. Aggregate FT for the prospective group (0.87 ± 0.68 minutes) was significantly lower compared to the retrospective group (1.09 ± 0.65 minutes) and resulted in a 25% reduction in average FT (P = .002). There was no statistically significant difference in the number of failed FGLPs between the two groups.
  
  
  CONCLUSIONS
  Our simulation-based FGLP curriculum resulted in improved operator confidence and reduced FT. These changes suggest that resident procedure efficiency was improved, whereas patient dose was reduced. The FGLP training program was implemented by radiology residents and required a minimal investment of time and resources. The LP spine phantom used during training was inexpensive, durable, and effective. In addition, the phantom is compatible with multiple modalities including fluoroscopy, computed tomography, and ultrasound and could be easily adapted to other applications such as facet injections or joint arthrograms.
authors: Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Hwy, UTMC Nuclear Medicine, Knoxville, TN 37920.
authors: Austin R
authors: AR
authors: Faulkner
authors: Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Hwy, UTMC Nuclear Medicine, Knoxville, TN 37920.
authors: Austin C
authors: AC
authors: Bourgeois
authors: Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Hwy, UTMC Nuclear Medicine, Knoxville, TN 37920.
authors: Yong C
authors: YC
authors: Bradley
authors: Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Hwy, UTMC Nuclear Medicine, Knoxville, TN 37920.
authors: Kathleen B
authors: KB
authors: Hudson
authors: Department of Biostatistics, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
authors: R Eric
authors: RE
authors: Heidel
authors: Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Hwy, UTMC Nuclear Medicine, Knoxville, TN 37920; Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee. Electronic address: alexander.pasciak@gmail.com.
authors: Alexander S
authors: AS
authors: Pasciak
mesh_terms: D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005471:Fluoroscopy; D006801:Humans; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D015642:Radiology, Interventional / Q000193:education*; D012189:Retrospective Studies; D013129:Spinal Puncture
keywords: Lumbar puncture; dose reduction; fluoroscopy; simulation training