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Ultrasound-guided facet joint injection training using Perk Tutor

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Abstract

Purpose

Facet syndrome is a condition that may cause 15–45 % of chronic lower back pain. It is commonly diagnosed and treated using facet joint injections. This needle technique demands high accuracy, and ultrasound (US) is a potentially useful modality to guide the needle. US-guided injections, however, require physicians to interpret 2-D sonographic images while simultaneously manipulating an US probe and needle. Therefore, US-guidance for facet joint injections needs advanced training methodologies that will equip physicians with the requisite skills.

Methods

We used Perk Tutor—an augmented reality training system for US-guided needle insertions—in a configuration for percutaneous procedures of the lumbar spine. In a pilot study of 26 pre-medical undergraduate students, we evaluated the efficacy of Perk Tutor training compared to traditional training.

Results

The Perk Tutor Trained group, which had access to Perk Tutor during training, had a mean success rate of 61.5 %, while the Control group, which received traditional training, had a mean success rate of 38.5 % (\(p = 0.031\)). No significant differences in procedure times or needle path lengths were observed between the two groups.

Conclusions

The results of this pilot study suggest that Perk Tutor provides an improved training environment for US-guided facet joint injections on a synthetic model.

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References

  1. Boswell M, Singh V, Staats PS, Hirsch JA (2003) Accuracy of precision diagnostic blocks in the diagnosis of chronic spinal pain of facet or zygapophysial joint origin: a systematic review. Pain Phys 6:449–456

    Google Scholar 

  2. Boswell M, Colson J, Sehgal N, Dunbar E, Epter R (2007) A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Phys 10:229–253

    Google Scholar 

  3. Chen CP, Lew HL, Tsai WC, Hung YT, Hsu CC (2011) Ultrasound-guided injection techniques for the low back and hip joint. Am J Phys Med Rehabil 90:860–867

    Article  PubMed  Google Scholar 

  4. Clarke C, Moore J, Wedlake C, Lee D, Ganapathy S, Salbalbal M, Wilson T, Peters T, Bainbridge D (2010) Virtual reality imaging with real-time ultrasound guidance for facet joint injection: a proof of concept. Anesth Analg 110:1461–1463

    Article  PubMed  Google Scholar 

  5. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R, (2012) 3D slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30:1323–1341

    Google Scholar 

  6. Galiano K, Obwegeser A, Bodner G, Freund M, Maurer H, Kamelger F, Schatzer R, Ploner F (2005) Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled feasibility study. Anesth Analg 101:579–583

    Article  PubMed  Google Scholar 

  7. Galiano K, Obwegeser AA, Walch C, Schatzer R, Ploner F, Gruber H (2007) Ultrasound-guided versus computed tomography-controlled facet joint injections in the lumbar spine: a prospective randomized clinical trial. Reg Anesth Pain Med 32:317–322

    Google Scholar 

  8. Lasso A, Heffter T, Pinter C, Ungi T, Fichtinger G (2012) Implementation of the plus open-source toolkit for translational research of ultrasound-guided intervention systems. In: MICCAI, pp 1–12

  9. Ma IW, Brindle ME, Ronksley PE, Lorenzetti DL, Sauve RS, Ghali WA (2011) Use of simulation-based education to improve outcomes of central venous catheterization: a systematic review and meta-analysis. Acad Med 86:1137–1147

    Google Scholar 

  10. Magee D, Zhu Y, Ratnalingam R, Gardner P, Kessel D (2007) An augmented reality simulator for ultrasound guided needle placement training. Med Biol Eng Comput 45:957–967

    Article  PubMed  CAS  Google Scholar 

  11. Moore J, Clarke C, Bainbridge D, Wedlake C, Wiles A, Pace D, Peters T (2009) Image guidance for spinal facet injections using tracked ultrasound. In: MICCAI vol 523, pp 516–523

  12. Sehgal N, Dunbar EE, Shah RV, Colson J (2007) Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update. Pain Phys 10:213–228

    Google Scholar 

  13. Tokuda J, Fischer GS, Papademetris X, Yaniv Z, Ibanez L, Cheng P, Liu H, Blevins J, Arata J, Golby AJ, Kapur T, Pieper S, Burdette EC, Fichtinger G, Tempany CM, Hata N (2009) OpenIGTLink: an open network protocol for image-guided therapy environment. Int J Med Robot 5:423–434

    Article  PubMed  Google Scholar 

  14. Ungi T, Abolmaesumi P, Jalal R, Welch M, Ayukawa I, Nagpal S, Lasso A, Jaeger M, Borschneck DP, Fichtinger G, Mousavi P (2012) Spinal needle navigation by tracked ultrasound snapshots. IEEE Trans Biomed Eng 59(10):2766–2772

    Article  PubMed  Google Scholar 

  15. Ungi T, Sargent D, Moult E, Lasso A, Pinter C, McGraw R, Fichtinger G (2012) Perk Tutor: an open-source training platform for ultrasound-guided needle insertions. IEEE Trans Biomed Eng 59(12):3475–3481

    Google Scholar 

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Acknowledgments

The authors wish to thank Jennifer Andrea and Kim Garrison for their kind assistance in setting up the Perk Tutor system.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to T. Ungi.

Additional information

E. Moult and M. Welch were supported by the NSERC USRA program. G. Fichtinger was supported as a Cancer Care Ontario Research Chair. T. Ungi was supported as an Ontario Ministry of Research and Innovation Postdoctoral Fellow.

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Moult, E., Ungi, T., Welch, M. et al. Ultrasound-guided facet joint injection training using Perk Tutor. Int J CARS 8, 831–836 (2013). https://doi.org/10.1007/s11548-012-0811-5

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  • DOI: https://doi.org/10.1007/s11548-012-0811-5

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