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3D Printed Percutaneous Transhepatic Cholangiography and Drainage (PTCD) Simulator for Interventional Radiology

  • Laboratory Investigation
  • Biliary
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Learning how to perform percutaneous transhepatic bile duct drainage (PTCD) is challenging for interventional radiology (IR) trainees. Therefore, simulators are crucial for IR training and are being increasingly demanded in the evolving healthcare environment of value-based care. To facilitate interventional training, we tried to evaluate our newly developed liver phantom for further use in IR training.

Methods

We developed a liver phantom with a flexible hollow biliary tree, hydrogel-based liver parenchyma, plastic ribs, and silicone skin. The phantom was evaluated by 20 radiology residents from two hospitals. After an introduction, all participants tried to obtain biliary access by fluoroscopic guidance within 25 min. Puncture time, fluoroscopy time, and kerma area product were measured. After 7 days, the participants repeated the procedure on an altered and more difficult model. Additionally, a survey was handed out to every participant (20 residents, 5 experts, and 5 IR fellows) to evaluate the phantom in terms of accuracy and haptic feedback, as well as general questions regarding simulation.

Results

The residents performed significantly faster and were more self-confident on Day 7 than on Day 1, significantly decreasing puncture time, fluoroscopy time, and kerma area product (p ≤ 0.0001). The participants were very satisfied with their simulation experience and would trust themselves more in real-life scenarios.

Conclusion

We were able to develop a phantom with high anatomical accuracy for fluoroscopy and ultrasound-guided interventions. The phantom successfully helped residents learn and improve their PTCD performance.

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References

  1. Venkatanarasimha N, Damodharan K, Gogna A, Leong S, Too CW, Patel A, Tay KH, Tan BS, Lo R, Irani F. Diagnosis and management of complications from percutaneous biliary tract interventions. Radiographics. 2017;37:665–80. https://doi.org/10.1148/rg.2017160159.

    Article  PubMed  Google Scholar 

  2. Degiorgio S, Gerasia R, Liotta F, Maruzzelli L, Cortis K, Miraglia R, Luca A. Radiation doses to operators in hepatobiliary interventional procedures. Cardiovasc Interv Radiol. 2018;41(5):772–80. https://doi.org/10.1007/s00270-017-1870-3.

    Article  Google Scholar 

  3. Miller ZA, Amin A, Tu J, Echenique A, Winokur RS. Simulation-based training for interventional radiology and opportunities for improving the educational paradigm. Tech Vasc Interv Radiol. 2019;22:35–40. https://doi.org/10.1053/j.tvir.2018.10.008.

    Article  PubMed  Google Scholar 

  4. Mirza S, Athreya S. Review of simulation training in interventional radiology. Acad Radiol. 2018;25:529–39. https://doi.org/10.1016/j.acra.2017.10.009.

    Article  PubMed  Google Scholar 

  5. Lopez Benítez R, Reyes del Castillo T, Benz D, et al. Percutaneous transhepatic biliary puncture simulator a cord network prototype. Adv Simul. 2021. https://doi.org/10.1186/s41077-021-00178-w.

    Article  Google Scholar 

  6. Kaufmann R, Zech CJ, Takes M, et al. Vascular 3D printing with a novel biological tissue mimicking resin for patient-specific procedure simulations in interventional radiology: a feasibility study. J Digit Imaging. 2022;35(1):9–20. https://doi.org/10.1007/s10278-021-00553-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Patel R, Dennick R. Simulation based teaching in interventional radiology training: is it effective? Clin Radiol. 2017;72:266.e7-266.e14. https://doi.org/10.1016/j.crad.2016.10.014.

    Article  CAS  PubMed  Google Scholar 

  8. Arnolli MM, Buijze M, Franken M, de Jong KP, Brouwer DM, Broeders IAMJ. System for CT-guided needle placement in the thorax and abdomen: a design for clinical acceptability, applicability and usability. Int J Med Robot. 2018. https://doi.org/10.1002/rcs.1877.10.1002/rcs.1877.

    Article  PubMed  Google Scholar 

  9. Fortmeier D, Mastmeyer A, Schroder J, Handels H. A virtual reality system for PTCD simulation using direct visuo-haptic rendering of partially segmented image data. IEEE J Biomed Health Inform. 2016;20(1):355–66. https://doi.org/10.1109/jbhi.2014.2381772.

    Article  PubMed  Google Scholar 

  10. Mastmeyer A, Wilms M, Handels H. Interpatient respiratory motion model transfer for virtual reality simulations of liver punctures. arXiv preprint 2017 arXiv:1707.08554.

  11. Villard PF, Vidal FP, Hunt C, et al. A prototype percutaneous transhepatic cholangiography training simulator with real-time breathing motion. Int J Comput Assist Radiol Surg. 2009;4(6):571–8. https://doi.org/10.1007/s11548-009-0367-1.

    Article  CAS  PubMed  Google Scholar 

  12. Mastmeyer A, Fortmeier D, Handels H. Evaluation of direct haptic 4D volume rendering of partially segmented data for liver puncture simulation. Sci Rep. 2017. https://doi.org/10.1038/s41598-017-00746-z.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tan X, Li D, Jeong M, et al. Soft liver phantom with a hollow biliary system. Ann Biomed Eng. 2021;49(9):2139–49. https://doi.org/10.1007/s10439-021-02726-x.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to thank all the participants, who trained and evaluated our simulator.

Funding

This study was not supported by any funding.

Author information

Author notes

  1. Carsten Fechner and Tomás Reyes del Castillo contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000, Lucerne, Switzerland

    Carsten Fechner, Tomás Reyes del Castillo, Justus Erasmus Roos & Rubén López Benítez

  2. Department of Interventional Radiology, Basel University Hospital, 4031, Basel, Switzerland

    Christoph Johannes Zech & Martin Takes

Authors
  1. Carsten Fechner
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  2. Tomás Reyes del Castillo
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  3. Justus Erasmus Roos
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  4. Christoph Johannes Zech
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  5. Martin Takes
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  6. Rubén López Benítez
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Contributions

CF designed the study and phantom. CF and TR collected the data and wrote the paper. CF edited and submitted the final paper. JR, CZ, MT and RL provided expertise and supervised the study. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Carsten Fechner.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Consent for publication was obtained for every individual person’s data included in the study.

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Fechner, C., Reyes del Castillo, T., Roos, J.E. et al. 3D Printed Percutaneous Transhepatic Cholangiography and Drainage (PTCD) Simulator for Interventional Radiology. Cardiovasc Intervent Radiol 46, 500–507 (2023). https://doi.org/10.1007/s00270-022-03347-0

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  • DOI: https://doi.org/10.1007/s00270-022-03347-0

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