BACKGROUND:This study aims to evaluate the effectiveness of simulator-based repetitive training on the aseptic non-touch IV placement technique using an ultrasound-guided peripheral vascular access (USPVA) simulator among physicians working in the emergency department (ED), anesthesiology, and medical intensive care units (ICUs) at a tertiary training hospital. METHODS:In this prospective randomized study, participants received theoretical training, then randomized into two groups and performed USPVA on the simulator. The simulated vessels were at 5, 10, and 15 mm depths with 2, 4, and 6 mm diameters, respectively. Finally, pre- and post-questionnaires and simulator data were analyzed. RESULTS:A total of 36 physicians, (18 from ED, 9 from anesthesiology and 9 from ICU) participated in the study. Training on the simulator significantly improved the success rate of vascular access (62.5% (135/216)) compared to baseline values (31.9% (69/216); p < 0.001). There was a significant increase in the successful application of the aseptic non-touch technique after the training (96.2% (208/216)) compared to pre-training (42.5% (92/216); p < 0.001). The survey results showed that participants acquired new knowledge related to the aseptic non-touch technique through simulator-based training. CONCLUSION:This study demonstrates the successful implementation of aseptic non-touch technique for USPVA training for physicians using a mixed reality simulator.

Objective: Design refinement and validation with simulated physical prostates of a planning, guidance, and feedback system for visualizing prostate biopsy in 3D perspective. Methods: A visualized prostate biopsy system (vPBx) using electromagnetic tracking of a transrectal ultrasound (TRUS) probe, a biopsy device, and a urinary catheter placed inside the patient’s prostate was refined and integrated as a reversible retrofit to a Flex Focus 400 ultrasound machine (BK Medical). The system was verified using simulated physical prostates with 12 0.065 ml (2.5 mm radius) spheres, arranged in a double sextant template, registered to a virtual model of the prostate and used to distinguish hits and misses. Systematic prostate biopsy (sPBx) was performed on simulated prostates using the vPBx as a retrofit to the TRUS machine. Results: The vPBx system enabled an inexperienced user to sample the sPBx template locations with a template deviation below 2.5 mm. Conclusion: An electromagnetic guidance system was refined, retrofitted with a Flex Focus 400 machine and a side-cut biopsy device (Max-Core Disposable Core Biopsy Instrument; Bard) and successfully validated with simulated physical prostates. Significance: If validated with patients, the vPBx system has the potential to reduce prostate biopsy false negatives, which may lead to earlier diagnosis of clinically significant prostate cancer and improved 10-year mortality in high risk prostate cancer patients.

INTRODUCTION:We describe the development and validation of a mixed-reality prostate biopsy (PBx) simulator with built-in guidance aids and real-time 3-dimensional visualization.METHODS:We evaluated our simulator during one-on-one training sessions with urology residents and attendings from 2018 to 2022. Participants performed freehand, side-fire, double-sextant transrectal ultrasound-guided systematic prostate biopsy (sPBx). After a baseline assessment (first set of 12 biopsy cores), participants trained for 25 minutes with visualization and cognitive aids activated. Training was followed by an exit set of 12 biopsy cores without visualization or cognitive aids and afterward, subjective assessment by trainees of the simulator. Deviation is the shortest distance of the center of a core from its intended template location.RESULTS:Baseline deviations (mean ± SD) for residents (n = 24) and attendings (n = 4) were 13.4 ± 8.9 mm and 8.5 ± 3.6 mm ( P < 0.001), respectively. Posttraining deviations were 8.7 ± 6.6 mm and 7.6 ± 3.7 mm ( P = 0.271), respectively. Deviations between baseline and exit were decreased significantly for residents ( P < 0.001) but not for attendings ( P = 0.093). Overall feedback from participants was positive. Confidence in performing a PBx increased in novices after training ( P = 0.011) and did not change among attendings ( P = 0.180).CONCLUSIONS:A new PBx simulator can quantify and improve accuracy during simulated freehand sPBx while providing visualization and graphical feedback. Improved simulated sPBx accuracy could lead to more even distribution of biopsy cores within the prostate when performed in clinical settings, possibly reducing the high risk of missing an existing lesion and thus decreasing the time to initiating treatment, if indicated.

Abstract Background The purpose of this study is to assess the feasibility of mixed-reality (MixR) visualization for patient setup in breast and chest wall radiotherapy (RT) by performing a first-in-human clinical trial comparing MixR with a 3-point alignment. Methods IRB approval was granted for a study incorporating MixR during the setup process for patients undergoing proton (n = 10) or photon (n = 8) RT to the breast or chest wall. For each patient, MixR was utilized for five fractions and compared against another five fractions using 3-point alignment. During fractions with MixR, the patient was aligned by at least one therapist wearing a HoloLens 2 device who was able to guide the process by simultaneously and directly viewing the patient and a hologram of the patient’s surface derived from their simulation CT scan. Alignment accuracy was quantified with cone-beam CT (CBCT) for photon treatments and CBCT plus kV/kV imaging for proton treatments. Registration time was tracked throughout the setup process as well as the amount of image guidance (IGRT) utilized for final alignment. Results In the proton cohort, the mean 3D shift was 0.96 cm using 3-point alignment and 1.18 cm using MixR. An equivalence test indicated that the difference in registration accuracy between the two techniques was less than 0.5 cm. In the photon cohort, the mean 3D shift was 1.18 cm using 3-point alignment and 1.00 cm using MixR. An equivalence test indicated that the difference in registration accuracy was less than 0.3 cm. Minor differences were seen in registration time and the amount of IGRT utilization. Conclusions MixR for patient setup for breast cancer RT is possible at the level of accuracy and efficiency provided by a 3-point alignment. Further developments in marker tracking, feedback, and a better understanding of the perceptual challenges of MixR are needed to achieve a similar level of accuracy as provided by modern surface-guided radiotherapy (SGRT) systems. Trial registration ClinicalTrials.gov, UFHPTI 2015-BR05: Improving Breast Radiotherapy Setup and Delivery Using Mixed-Reality Visualization, NCT05178927.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

Summary Statement Using a simulated adult COVID-19 patient with hypoxemia, we investigated whether caregivers interrupting oxygen flow by manually occluding oxygen tubing with pliers during exhalation can conserve oxygen while maintaining oxygenation. Oxygen pinching reduced oxygen use by 51% to 64%, maintained simulated oxygen saturation between 88% and 90%, and increased simulated average alveolar partial pressure of oxygen from a room air baseline of approximately 131 to 294–424 mm Hg compared with 607 mm Hg with 10 liters per minute (LPM) continuous oxygen flow. Simulation provided a methodology to rapidly evaluate a technique that has begun to be used with COVID-19 patients in low-resource environments experiencing an acute oxygen shortage.

Introduction Continuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator. Methods This prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator. Results All 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F9,108 = 11.7, p < 0.001), percent of first words correct (F9,108 = 13.6, p < 0.001), and overall percent hint-based score (F9,108 = 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman's rho = 0.67, p = 0.023). Conclusions A self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.

We read with interest Dr. Philip Liu’s (1) review of the book titled Simulators in Anesthesiology Education (2), which contains the proceedings of a conference by the same name held in 1996. At the outset, we must disclose that one of us (DMG) contributed to this volume a chapter concerning research methodologies involving patient simulators. We were surprised by the rather abrupt transition at the end of Dr. Liu’s review from analyzing the strengths and weaknesses of the book to expressing his personal opinions about the value of realistic patient simulators to anesthesiology education. First, by mixing such opinions with his book review, Dr. Liu does a disservice to the editors and authors of this book and to the readers of Anesthesia & Analgesia. More importantly, Dr. Liu’s opinion that patient simulators are a luxury is unsubstantiated. To our knowledge, no claim has been made by anyone with first-hand experience using patient simulators in anesthesia education, or anywhere in the book under review, that every residency program must have a simulator. Each institution must, and does, judge the value of this (or any other) technology for its own purposes. Many institutions have decided that the value exceeds the costs. In fact, since Dr. Liu wrote his review stating that there are approximately 50 simulation centers around the world, there are now well over 100, and this number is increasing every month. Second, Dr. Liu argues that there is an enormous cost associated with simulators and their operation. However, the hardware and software costs are not excessive when compared with other clinical anesthesia devices, such as transesophageal echocardiography or evoked potential monitoring equipment, whose costs are similarly amortized over the useful life of the device. Importantly, in many simulation centers, these costs are commonly shouldered by a variety of users, not just by anesthesiologists. Dr. Liu ignores both the information provided in the book he reviewed and the now large body of literature on the wide spectrum of uses for patient simulators. To date, applications span education (medical students, classroom school teachers, college students) and clinical training (see below) to performance assessment, research on human factors (such as equipment design and the effects of fatigue), and even preprocurement testing of equipment. As for training, beyond anesthesiology, simulators have now been used for training residents and experienced clinicians in many domains including: combined delivery room teams (e.g., obstetricians, anesthesiologists, neonatologists, and neonatal intensive care unit nurses); emergency room teams; prehospital emergency responders, intensive care physicians, and intensive care unit teams; in-hospital resuscitation teams; and radiologists. As evidence of the widespread interest in simulator use outside anesthesiology, at a recent patient simulator workshop at the University of California San Diego, nonanesthesiologist participants out-numbered anesthesiologists by a ratio of 3 to 2, and virtually every clinical specialty was represented, including psychiatry, family medicine, internal medicine, surgery, radiology, orthopedics, pharmacology, physiology, bioengineering, emergency medicine, nursing, neurology, and reproductive medicine. Therefore, we believe that it is no longer an issue of whether every anesthesia residency can use a simulator—the question now is whether every health care institution can reap benefits from simulation technology. In fact, anesthesiologists are the acknowledged leaders in the use of simulation for clinical training, and we are sought by many other disciplines for advice and counsel in this regard. Dr. Liu points out that simulation usage would be bolstered by the adoption by the American Board of Anesthesiology of simulation-based examinations. No doubt this is true. The American Board of Anesthesiology has been studying the use of simulators for this purpose for over 10 yr. The road to simulation-based examinations will be long and slow, but this application, too, will probably be with us in the future. Interestingly, a member of the American Board of Internal Medicine who attended the University of California San Diego simulator workshop expressed the opinion that realistic simulators may similarly have a role in the certification process for internists. Finally, Dr. Liu suggests that we have “…successfully developed a ‘learn and earn’ system of resident education.” Few of us would argue that this system is perfect, or that its graduates are 100% optimal in all respects. Nearly every other high-hazard industry uses a similar “learn and earn” approach where more junior personnel operate under close supervision of those with more experience. Yet, many of these domains also conduct simulation training for these personnel, especially, as Dr. Liu himself recognizes, in “…situations that could not be offered safely in any other environment.” Thus, whether having access to a simulator is a luxury or a necessity has by no means been established. In our opinion, Dr. Liu’s judgements, grafted unnecessarily onto his book review, are biased, unsubstantiated, and, if nothing else, markedly premature. A more appropriate conclusion to his review would have been to congratulate the book’s editors and authors for their compilation of the state-of-the-art at the time of the conference. Another conference on simulation in anesthesiology education was held June 1999. Although it’s unlikely that the “quintessential education application for simulators” was delineated at this conference, the spectrum of simulation-based activities around the world was probably impressive. David M. Gaba MD Steve Howard MD Brian Smith MD Matthew B. Weinger MD

Background: Prostate biopsy false negative percentages are 21% to 47% and 16% to 30% for systematic and fused biopsy, respectively. An intuitive three-dimensional (3D) observed user interface may help reduce these percentages by providing real-time guidance and feedback during transrectal or transperineal biopsy. Materials and Methods: We track the moving prostate (including template locations and regions of interest), the transrectal ultrasound (TRUS) probe, and the biopsy device to construct a 3D environment. Users observe, aim, sample, and receive feedback in real time. Using a simulator with simulated TRUS, 48 participants performed freehand systematic prostate biopsy with traditional TRUS guidance and afterward with visualized prostate biopsy (vPBx). Results: During simulated biopsy, vPBx reduced the false negative percentage for a 0.5-mL spherical apical lesion from 52% to 2% (p < 0.001). Conclusions: Preliminary results during simulated systematic biopsy warrant retrofitting the vPBx to actual TRUS equipment as a step toward clinical trials with patients.

INTRODUCTION:Different simulators often share elements, resulting in different laboratories doing redundant work. This can lead to higher development and acquisition costs, proprietary, incompatible technology, lack of interoperability, and large inventories that reduce accessibility to the benefits of simulation. Simulation technology can become more affordable and scalable with open architecture and modular design. We describe the System of Modular Mixed and Augmented Reality Tracking Simulators (SMMARTS) open architecture, rapid development platform for designing and building modular procedural and guided-intervention simulators.METHODS:A modular stand provides mechanical indexing (registration) of a modular anatomical block representing the anatomy relevant to the simulated intervention. A software development kit (SDK) integrated with the hardware (stand and hand-held tracked tools such as a needle and ultrasound probe) facilitates software development. The SMMARTS SDK at https://github.com/UF-CSSALT/SMMARTS-SDK developed in Unity Technologies' Unity game engine includes Arduino microcontroller and NDI's 6 degrees of freedom tracking connectivity along with software tools such as a replayer, user interface templates, 3D visualization of the virtual counterparts of physical elements, scoring monitors, cognitive aids, common error messages, and Experience Application Programming Interface compatibility.RESULTS:We used SMMARTS to develop 9 different simulators internally (instructor-less central venous access currently deployed to Iraq, prostate biopsy, epidural loss-of-resistance, ventriculostomy, pterygopalatine fossa block, lumbar/chronic pain blocks, chest tube insertion) and externally (intravenous access).DISCUSSION:As a living tool, SMMARTS now has sufficient functionality and benefits that we can share it to help clinicians and engineers focus more on content specific to learning objectives rather than back-end tasks.

ObjectivesTo develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side‐fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false‐negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer.Participants and MethodsUsing a PBx simulator with real‐time three‐dimensional visualization, we devised a freehand, pitch‐neutral (0°, horizontal plane), side‐fire, transrectal ultrasonography (TRUS)‐guided sPBx technique in the left lateral decubitus position. Thirty‐four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double‐sextant template as well as the TRUS probe pitch at the time of sampling. We defined deviation as the shortest distance in millimeters between a core centre and its intended template location, template deviation as the mean of all deviations in a template, and mastery as achieving a template deviation ≤5.0 mm.ResultsAll results are reported as mean ± sd. The mean absolute pitch and template deviation before learning the technique (baseline) were 8.2 ± 4.1° and 8.0 ± 2.7 mm, respectively, and after mastering the technique decreased to 4.5 ± 2.7° (P = 0.001) and 4.5 ± 0.6 mm (P < 0.001). Template deviation was related to mean absolute pitch (P < 0.001) and increased by 0.5 mm on average with each 1° increase in mean absolute pitch. Participants achieved mastery after practising 3.9 ± 2.9 double‐sextant sets. There was no difference in time to perform a double‐sextant set at baseline (277 ± 102 s) and mastery (283 ± 101 s; P = 0.39).ConclusionA pitch‐neutral side‐fire technique reduced template deviation during simulated freehand TRUS‐guided sPBx, suggesting it may also reduce PBx false‐negatives in patients in a future clinical trial. This pitch‐neutral technique can be taught and learned; the University of Florida has been teaching it to all Urology residents for the last 2 years.

Introduction Different simulators often share elements, resulting in different laboratories doing redundant work. This can lead to higher development and acquisition costs, proprietary, incompatible technology, lack of interoperability, and large inventories that reduce accessibility to the benefits of simulation. Simulation technology can become more affordable and scalable with open architecture and modular design. We describe the System of Modular Mixed and Augmented Reality Tracking Simulators (SMMARTS) open architecture, rapid development platform for designing and building modular procedural and guided-intervention simulators. Methods A modular stand provides mechanical indexing (registration) of a modular anatomical block representing the anatomy relevant to the simulated intervention. A software development kit (SDK) integrated with the hardware (stand and hand-held tracked tools such as a needle and ultrasound probe) facilitates software development. The SMMARTS SDK at https://github.com/UF-CSSALT/SMMARTS-SDK developed in Unity Technologies' Unity game engine includes Arduino microcontroller and NDI's 6 degrees of freedom tracking connectivity along with software tools such as a replayer, user interface templates, 3D visualization of the virtual counterparts of physical elements, scoring monitors, cognitive aids, common error messages, and Experience Application Programming Interface compatibility. Results We used SMMARTS to develop 9 different simulators internally (instructor-less central venous access currently deployed to Iraq, prostate biopsy, epidural loss-of-resistance, ventriculostomy, pterygopalatine fossa block, lumbar/chronic pain blocks, chest tube insertion) and externally (intravenous access). Discussion As a living tool, SMMARTS now has sufficient functionality and benefits that we can share it to help clinicians and engineers focus more on content specific to learning objectives rather than back-end tasks.

Develop and pilot test a simulator that presents ten commonly encountered representative clinical contexts for trainees to learn basic electroencephalogram (EEG) interpretation skills. We created an interactive web-based training simulator that allows self-paced, asynchronous learning and assessment of basic EEG interpretation skills. The simulator uses the information retrieval process via a free-response text box to enhance learning. Ten scenarios were created that present dynamic (scrolling) EEG tracings resembling the clinical setting, followed by questions with free-text answers. The answer was checked against an accepted word/phrase list. The simulator has been used by 76 trainees in total. We report pilot study results from the University of Florida’s neurology residents (N = 24). Total percent correct for each scenario and average percent correct for all scenarios were calculated and correlated with most recent In-training Examination (ITE) and United States Medical License Examination (USMLE) scores. Neurology residents’ mean percent correct scenario scores ranged from 27.1–86.0% with an average scenario score of 61.2% ± 7.7. We showed a moderately strong correlation r = 0.49 between the ITE and the average scenario score. We developed an online interactive EEG interpretation simulator to review basic EEG content and assess interpretation skills using an active retrieval approach. The pilot study showed a moderately strong correlation r = 0.49 between the ITE and the average scenario score. Since the ITE is a measure of clinical practice, this is evidence that the simulator can provide self-directed instruction and shows promise as a tool for assessment of EEG knowledge.

Introduction Postdural puncture headache due to accidental dural puncture is a consequence of excessive needle tip overshoot distance after entering the epidural space via a loss of resistance (LOR) technique. We are not aware of any quantitative comparison of the magnitude of needle tip overshoot (distance traveled by the needle tip beyond the point where LOR can be discerned) for the various LOR assessment techniques that are taught. Such a comparison may provide insight into contributing factors of accidental dural puncture and associated postdural puncture headache. Methods A custom-built simulator was used to evaluate the following 3 LOR assessment techniques: incremental needle advancement, intermittent LOR assessment (II); continuous needle advancement, high-frequency intermittent LOR assessment (CI); and continuous needle advancement, continuous LOR assessment (CC). Results There were significant mean differences in maximum overshoot past a virtual LOR plane due to technique ( F (2,124) = 79.31, P < 0.001) (Fig. 2). Specifically, maximum overshoot was greater with technique II [mean = 3.8 mm, 95% confidence interval (CI) = 3.4–4.3] versus either CC (mean = 1.9 mm, 95% CI = 1.5–1.8, P < 0.001) or CI (mean = 1.4 mm, 95% CI = 0.9–2.3, P < 0.001). Differences in maximum overshoot between CC and CI were not statistically different ( P = 0.996). Maximum overshoot was greater at 4 cm (mean = 3.0 mm, 95% CI = 2.6–3.4) compared with 5 cm (mean = 2.3 mm, 95% CI = 2.0–2.5, P = 0.044), 6 cm (mean = 2.0 mm, 95% CI = 1.9–2.2, P = 0.054), 7 cm (mean = 1.9 mm, 95% CI = 1.7–2.1, P = 0.002), and 8 cm (mean = 1.8 mm, 95% CI = 1.6–2.1, P = 0.001). In addition, maximum overshoot at 5 cm was greater than that at 7 cm ( P = 0.020) and 8 cm ( P = 0.037). The other LOR depths were not statistically significantly different from each other. Depth did not have a significant interaction with technique ( P = 0.517). Technique preference had neither a significant relationship to maximum overshoot ( P = 0.588) nor a significant interaction with LOR assessment technique ( P = 0.689). Discussion Technique II LOR assessment produced the greatest needle overshoot past the simulated LOR plane after obtaining LOR. This was consistent across all LOR depths. In this bench study, the II technique resulted in the deepest needle tip maximum overshoot. We are in the process of designing a clinical study to collect similar data in patients.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II (MP35)1 Apr 2019MP35-01 BASELINE PREVALENCE AND MAGNITUDE OF SPATIAL DEVIATIONS IN A SIMULATOR FROM THE TRANSRECTAL ULTRASOUND PROSTATE BIOPSY TEMPLATE Samsun Lampotang, Thomas Stringer, Louis Moy, David Lizdas, Jonathan Wakim, Zhou Zhang, Yichao Yu, Lou Ann Cooper, and Brandon Otto* Samsun LampotangSamsun Lampotang More articles by this author , Thomas StringerThomas Stringer More articles by this author , Louis MoyLouis Moy More articles by this author , David LizdasDavid Lizdas More articles by this author , Jonathan WakimJonathan Wakim More articles by this author , Zhou ZhangZhou Zhang More articles by this author , Yichao YuYichao Yu More articles by this author , Lou Ann CooperLou Ann Cooper More articles by this author , and Brandon Otto*Brandon Otto* More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555931.36243.e8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: During templated transrectal ultrasound prostate biopsy (TRUS PBx), the closer the actual PBx samples match a desired template (resulting in uniform spatial distribution of samples including regions where PCa is likely) the higher the probability of sampling PCa and avoiding a false negative. A mental model for templated PBx is a set of 12 circles (2D representation of spheres construed as the recommended centers for the cylindrical biopsy cores) evenly distributed on a posterior-anterior view of the prostate. We set out to quantify the baseline (first attempt at sampling a 12-core set) prevalence and magnitude of deviation from the 12-circle template during simulated TRUS PBx by trainees and experienced urologic practitioners. METHODS: With IRB approval, 15 participants (12 residents, 3 faculty) performed a 12-core templated TRUS PBx using a mixed reality simulator: tracked TRUS probe (BK 8818), side-firing needle guide, tracked needle gun (Bard Max-Core MC1825). We measured the spatial deviation (mm) of the actual core center from each of the 12 templated centers for each study participant. The centers of the 12 target spheres are set in a plane parallel to, and 7 mm away, from the rectal surface of the prostate. RESULTS: Baseline deviations (averaged over 12 cores) ranged from 6.5 to 24.5 mm (Table). Two-thirds (10/15) of urologist participants achieved a baseline error (averaged over 12 cores) of 11 mm or less. The distribution of urologists for different error thresholds (mm) was: ≤7:1; ≤8:5; ≤9:6; ≤10:9; ≤11:10, ≤12:11. CONCLUSIONS: We have provided quantitative data about error prevalence and a means to readily measure and display error during templated TRUS PBx in a simulator. The baseline deviation in our study was high suggesting that the commonly used 12-circle mental/graphical 2D model may need reconsideration. The new TRUS PBx simulator may be helpful in developing and evaluating consensus guidelines about error thresholds and quantitatively comparing different templated TRUS PBx techniques. Source of Funding: Oberndorf donation to the Center for Safety, Simulation & Advanced Learning Technologies DOD Award W81XWH-14-1-0113 Gainesville, FL© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e503-e504 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samsun Lampotang More articles by this author Thomas Stringer More articles by this author Louis Moy More articles by this author David Lizdas More articles by this author Jonathan Wakim More articles by this author Zhou Zhang More articles by this author Yichao Yu More articles by this author Lou Ann Cooper More articles by this author Brandon Otto* More articles by this author Expand All Advertisement PDF downloadLoading ...