A High-Fidelity Agar-Based Phantom for Ultrasonography-Guided Brain Biopsy Simulation: A Novel Training Prototype with Visual Feedback

OBJECTIVE: A novel agar-based phantom was developed and assessed for ultrasonography (USG)-guided brain bi-opsy training. The phantom provides visual cues combined with sonologic cues, allowing multimodal training. Impact of multimodal training is evaluated through pretraining and posttraining trials.METHODS: Twenty-five participants were divided based on experience with USG-based procedures into familiar (double dagger 3 procedures performed in the past) (n = 14) and unfa-miliar (<3 procedures performed) (n = 11). Agar phantoms with an opaque top and transparent middle layer were constructed in transparent glass bowls, each having 12 embedded targets. Participants underwent 2 supervised trials of USG-guided biopsy with aluminum foil covering the glass bowls, eliminating visual cues. Between 2 trials, participants underwent unsupervised self-training on a phantom without foil cover, providing visual cues. Perfor-mance was measured through insonation efficiency (EfI), biopsy efficiency (EfB), efficiency score (Ef), error score (Er), and performance score (PS). Scores were compared between and within the 2 groups before and after training. Impact of the self-training session on subjective comfort levels with the procedure was assessed through feedback forms.RESULTS: Familiars had better pretraining EfB, Ef, Er, and PS (P < 0.001) compared with unfamiliars. After training, both performed similarly on all metrics. After training, fa-miliars improved only in EfI (P = 0.001), with the un-familiars showing significance in all metrics except EfI.CONCLUSIONS: Simulation and phantom-based models can never supplant training through supervised skill application in vivo but our model supplements training by enabling technical skill acquisition, especially for begin-ners in USG-guided brain biopsy.

Automated summary

A novel agar-based phantom was developed and assessed for ultrasonography (USG)-guided brain biopsy training. The impact of multimodal training was evaluated through pretraining and posttraining trials.