Simulation in Radiology: Diagnostic Techniques

  • Alexander Towbin


Radiology has evolved to become essentially two distinct but closely related fields: diagnostic and interventional radiology. The use of simulation is therefore diverse in its nature when applied to radiology. In this chapter, we present the role of simulation in diagnostic radiology, which includes not only its role for practitioner training, but its role as an education tool for our patients as they prepare to undergo potentially frightening procedures. Simulation has been utilized in very novel ways for these purposes, and we believe much of this material will be of interest to the reader and may provide others with potential beneficial applications to a variety of other specialties. In the second part of In the following chapter, the role of simulation in interventional radiology is presented. Given the nature of invasive radiology and its grounding as a procedure-centric specialty, simulation in this field is more similar to other interventional fields and has shown great promise.


Radiology Diagnostic radiology Ultrasound CT MRI Interventional radiology Phantoms 


  1. 1.
    Carter AJ, Greer ML, Gray SE, Ware RS. Mock MRI: reducing the need for anaesthesia in children. Pediatr Radiol. 2010;40:1368–74.PubMedCrossRefGoogle Scholar
  2. 2.
    Hallowell LM, Stewart SE, de Amorim E, Silva CT, Ditchfield MR. Reviewing the process of preparing children for MRI. Pediatr Radiol. 2008;38:271–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Rosenberg DR, Sweeney JA, Gillen JS, Kim J, Varanelli MJ, O’Hearn KM, et al. Magnetic resonance imaging of children without sedation: preparation with simulation. J Am Acad Child Adolesc Psychiatry. 1997;36:853–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Pressdee D, May L, Eastman E, Grier D. The use of play therapy in the preparation of children undergoing MR imaging. Clin Radiol. 1997;52:945–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Edwards AD, Arthurs OJ. Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol. 2011;41:1353–64.PubMedCrossRefGoogle Scholar
  6. 6.
    de Bie HM, Boersma M, Wattjes MP, Adriaanse S, Vermeulen RJ, Oostrom KJ, et al. Preparing children with a mock scanner training protocol results in high quality structural and functional MRI scans. Eur J Pediatr. 2010;169:1079–85.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Hartman JH, Bena J, McIntyre S, Albert NM. Does a photo diary decrease stress and anxiety in children undergoing magnetic resonance imaging? A randomized, controlled study. J Radiol Nurs. 2009;28:122–8.CrossRefGoogle Scholar
  8. 8.
    Segars WP, Mahesh M, Beck TJ, Frey EC, Tsui BM. Realistic CT simulation using the 4D XCAT phantom. Med Phys. 2008;35:3800–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Frush DP, Slack CC, Hollingsworth CL, Bisset GS, Donnelly LF, Hsieh J, et al. Computer-simulated radiation dose reduction for abdominal multidetector CT of pediatric patients. AJR Am J Roentgenol. 2002;179:1107–13.PubMedCrossRefGoogle Scholar
  10. 10.
    Joemai RM, Geleijns J, Veldkamp WJ. Development and validation of a low dose simulator for computed tomography. Eur Radiol. 2010;20:958–66.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Hanai K, Horiuchi T, Sekiguchi J, Muramatsu Y, Kakinuma R, Moriyama N, et al. Computer-simulation technique for low dose computed tomographic screening. J Comput Assist Tomogr. 2006;30:955–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Kim S, Yoshizumi TT, Frush DP, Toncheva G, Yin FF. Radiation dose from cone beam CT in a pediatric phantom: risk estimation of cancer incidence. AJR Am J Roentgenol. 2010;194:186–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Yoshizumi TT, Goodman PC, Frush DP, Nguyen G, Toncheva G, Sarder M, et al. Validation of metal oxide semiconductor field effect transistor technology for organ dose assessment during CT: comparison with thermoluminescent dosimetry. AJR Am J Roentgenol. 2007;188:1332–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Hurwitz LM, Yoshizumi TT, Goodman PC, Frush DP, Nguyen G, Toncheva G, et al. Effective dose determination using an anthropomorphic phantom and metal oxide semiconductor field effect transistor technology for clinical adult body multidetector array computed tomography protocols. J Comput Assist Tomogr. 2007;31:544–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Britten AJ, Crotty M, Kiremidjian H, Grundy A, Adam EJ. The addition of computer simulated noise to investigate radiation dose and image quality in images with spatial correlation of statistical noise: an example application to X-ray CT of the brain. Br J Radiol. 2004;77:323–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Fefferman NR, Bomsztyk E, Yim AM, Rivera R, Amodio JB, Pinkney LP, et al. Appendicitis in children: low-dose CT with a phantom-based simulation technique – initial observations. Radiology. 2005;237:641–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Winslow M, Xu XG, Yazici B. Development of a simulator for radiographic image optimization. Comput Methods Programs Biomed. 2005;78:179–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Fanti V, Marzeddu R, Massazza G, Randaccio P, Brunetti A, Golosio B. A Simulator for X-ray images. Radiat Prot Dosimetry. 2005;114:350–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Veldkamp WJ, Kroft LJ, van Delft JP, Geleijns J. A technique for simulating the effect of dose reduction on image quality in digital chest radiography. J Digit Imaging. 2009;22:114–25.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Desser TS. Simulation-based training: the next revolution in radiology education? J Am Coll Radiol. 2007;4:816–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Towbin AJ, Paterson B, Chang PJ. A computer-based radiology simulator as a learning tool to help prepare first-year residents for being on call. Acad Radiol. 2007;14:1271–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Towbin AJ, Paterson BE, Chang PJ. Computer-based simulator for radiology: an educational tool. Radiographics. 2008;28:309–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Ganguli S, Pedrosa I, Yam CS, Appignani B, Siewert B, Kressel HY. Part I: preparing first-year radiology residents and assessing their readiness for on-call responsibilities. Acad Radiol. 2006;13:764–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Yam CS, Kruskal J, Pedrosa I, Kressel H. Part II: preparing and assessing first-year radiology resident on-call readiness technical implementation. Acad Radiol. 2006;13:770–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Halsted MJ, Perry LA, Perry DJ, Benton C. Development of an interactive model for teaching emergency pediatric radiography: preliminary report. J Am Coll Radiol. 2005;2:701–3.PubMedCrossRefGoogle Scholar
  26. 26.
    Halsted MJ, Guluzian JK, Little IG, Perry LA, Perry D, Benton C. Development of a new instructional tool to increase the diagnostic accuracy of radiology residents interpreting emergency pediatric neuroradiology studies. J Am Coll Radiol. 2006;3(11):893–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Halsted MJ, Guluzian JK, Perry LA, Little IG, Benton C. What is normal? A clinically useful reference collection of pediatric radiology cases created within a PACS. J Am Coll Radiol. 2005;2:189–92.PubMedCrossRefGoogle Scholar
  28. 28.
    Monsky WL, Levine D, Mehta TS, Kane RA, Ziv A, Kennedy B, et al. Using a sonographic simulator to assess residents before overnight call. AJR Am J Roentgenol. 2002;178:35–9.PubMedCrossRefGoogle Scholar
  29. 29.
    LoRusso AP, Bassignani MJ, Harvey JA. Enhanced teaching of screening mammography using an electronic format. Acad Radiol. 2006;13:782–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Gutmark R, Halsted MJ, Perry L, Gold G. Use of computer databases to reduce radiograph reading errors. J Am Coll Radiol. 2007;4:65–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Ngo AV, Sze RW, Parisi MT, Sidhu M, Paladin AM, Weinberger E, et al. Cranial suture simulator for ultrasound diagnosis of craniosynostosis. Pediatr Radiol. 2004;34:535–40.PubMedCrossRefGoogle Scholar
  32. 32.
    Nicholson RA, Crofton M. Training phantom for ultrasound guided biopsy. Br J Radiol. 1997;70:192–4.PubMedGoogle Scholar
  33. 33.
    Harvey JA, Moran RE, Hamer MM, DeAngelis GA, Omary RA. Evaluation of a turkey-breast phantom for teaching freehand, US-guided core-needle breast biopsy. Acad Radiol. 1997;4:565–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Vidal FP, Villard PF, Holbrey R, John NW, Bello F, Bulpitt A, et al. Developing an immersive ultrasound guided needle puncture simulator. Stud Health Technol Inform. 2009;142:398–400.PubMedGoogle Scholar
  35. 35.
    Hassard MK, McCurdy LI, Williams JC, Downey DB. Training module to teach ultrasound-guided breast biopsy skills to residents improves accuracy. Can Assoc Radiol J. 2003;54:155–9.PubMedGoogle Scholar
  36. 36.
    Morehouse H, Thaker HP, Persaud C. Addition of Metamucil to gelatin for a realistic breast biopsy phantom. J Ultrasound Med. 2007;26:1123–6.PubMedGoogle Scholar
  37. 37.
    Meng K, Lipson JA. Utilizing a PACS-integrated ultrasound-guided breast biopsy simulation exercise to reinforce the ACR practice guideline for ultrasound-guided percutaneous breast interventional procedures during radiology residency. Acad Radiol. 2011;18:1324–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Phal PM, Brooks DM, Wolfe R. Sonographically guided biopsy of focal lesions: a comparison of freehand and probe-guided techniques using a phantom. AJR Am J Roentgenol. 2005;184:1652–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Rock BG, Leonard AP, Freeman SJ. A training simulator for ultrasound-guided percutaneous nephrostomy insertion. Br J Radiol. 2010;83:612–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Strohmaier WL, Giese A. Ex vivo training model for percutaneous renal surgery. Urol Res. 2005;33:191–3.PubMedCrossRefGoogle Scholar
  41. 41.
    Hammond L, Ketchum J, Schwartz BF. A new approach to urology training: a laboratory model for percutaneous nephrolithotomy. J Urol. 2004;172:1950–2.PubMedCrossRefGoogle Scholar
  42. 42.
    John BS, Rowland D, Patel U, Pilcher J, Anson K, Nassiri D. Evaluation of the accuracy of 3-dimensional ultrasonography of the kidney using an in vitro renal model. J Ultrasound Med. 2009;28:155–62.PubMedGoogle Scholar
  43. 43.
    Stein-Wexler R, Sanchez T, Roper GE, Wexler AS, Arieli RP, Ho C, et al. An interactive teaching device simulating intussusception reduction. Pediatr Radiol. 2010;40:1810–5.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Hayeri MR, Sze R. An easily constructed simulator facilitates training of radiologists in gastrojejunal tube insertion. Pediatr Radiol. 2010;40:1138–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations