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Ultrasound-guided facet joint injection training using Perk Tutor

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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.


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.


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.


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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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.

Author information

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).

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  • Facet joint injection
  • Ultrasound-guidance
  • Medical education
  • Simulation training
  • Perk Tutor