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Correspondence |

A Low-Cost Training Phantom for Lung Ultrasonography FREE TO VIEW

Han Ho Do, MD; Sanghun Lee, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, South Korea

CORRESPONDENCE TO: Han Ho Do, MD, Department of Emergency Medicine, Dongguk University Ilsan Hospital 27, Dongguk-ro Ilsandong-gu, Goyang Gyeonggi, Korea 10326


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1417-1419. doi:10.1016/j.chest.2016.09.033
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Published online

Lung ultrasonography (LUS) is a concept introduced recently to confirm problems associated with the lungs and the pleura. Since many international authors and organizations recommend LUS examination in clinical settings, there is a necessity to train clinicians in the identification of normal and pathologic findings associated with LUS. The purpose of this study was to create a low-cost ultrasonographic phantom to simulate normal and pathologic ultrasonographic findings of LUS. All aspects of this project were approved by the Institutional Review Board at the Dongguk University Ilsan Hospital (No. 2015-89).

To make the thoracic model with optimal elasticity and solidity for ultrasonographic examination, we created a gelatin model with various mixtures and concentrations. The concentration of gelatin was optimal when 20 g of gelatin was mixed with 60 mL of water; 1g of agar was appropriate as an additive. Tree branches and polyurethane dressing foam (Medifoam, Mundipharma, South Korea) were used to represent ribs and pleura (Fig 1). The gelatin and the agar used in this study were commercial products obtained from the local grocery store, and the phantom maintained its durability more than 1 month when refrigerated. Approximate cost for creating the phantom was $5.

Figure Jump LinkFigure 1 Lung ultrasonographic phantom. A, Phantom in container. B, Phantom with polyurethane dressing foam positioned at the bottom.Grahic Jump Location

Normal lung tissue, as well as lungs with pneumothorax, pulmonary edema, pleural effusion, and pneumonia, were simulated. To demonstrate the movement of pleura, dressing foam in contact with the phantom was moved repeatedly in a horizontal plane. In the case of the lung point of pneumothorax, dressing foam movement was limited to the middle half of the phantom. Dressing foam was soaked in water and moved repeatedly in a horizontal plane to make B lines. To demonstrate pleural effusion, a balloon filled with water was made to contact the bottom of the phantom.

A six-item questionnaire was administered to LUS imaging experts (three emergency medicine specialists and three intensivists) regarding normal lung findings and five pathologic findings—atelectasis, pneumothorax, pulmonary edema, pneumonia, and pleural effusion—made by using the phantom. For each question, six videos of the simulated findings were displayed on the screen, and the rater was asked to select the answer for the specific situations (Fig 2; Video 1). Rater agreement on the phantom for LUS was 100% for 36 questions. Every rater answered all six questions correctly. Table 1 shows the questions, answers, and agreement rates. Individual scores for normal and pathologic conditions in LUS were excellent, and interrater agreement was also excellent.

Figure Jump LinkFigure 2 Six-item questionnaire using video clips obtained from the phantom administered to the raters for accuracy assessment. A, Normal lung sliding with A line. B, Limited lung sliding with lung pulse. C, Lung point of pneumothorax. D, Pulmonary edema with B lines. E, Pneumonia. F, Pleural effusion.Grahic Jump Location

Table Graphic Jump Location
Table 1 Test Questions Administered to the Raters

A prior study by Rippey and Gawthrope attempted to create an LUS phantom. In that study, the authors used pork rib, chicken breast, and sponges to reproduce normal and pathologic lung conditions. Because animal products are used, the materials may produce unwanted odors and require infection control precautions. Furthermore, the model is highly perishable because of the use of animal products, and although it is less expensive than commercial models, cost is still a limiting factor.

In this study, a phantom was created that would be able to simulate the human lungs to be used in LUS training. The phantom in this study will help trainees become comfortable with LUS equipment and techniques, as well as make it possible to determine the pathologic findings in practical situations. In further investigations, improvements to the phantom, such as reinforcing the details and simulating other pathologic conditions, will be explored.

Volpicelli G. .Elbarbary M. .Blaivas M. .et al International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577-591 [PubMed]journal. [CrossRef] [PubMed]
 
See K.C. .Ong V. .Wong S.H. .et al Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists. Intensive Care Med. 2016;42:63-71 [PubMed]journal. [CrossRef] [PubMed]
 
Rippey J. .Gawthrope I. . Creating thoracic phantoms for diagnostic and procedural ultrasound training. Australasian J Ultrasound Med. 2012;15:43-54 [PubMed]journal. [CrossRef]
 

Figures

Figure Jump LinkFigure 1 Lung ultrasonographic phantom. A, Phantom in container. B, Phantom with polyurethane dressing foam positioned at the bottom.Grahic Jump Location
Figure Jump LinkFigure 2 Six-item questionnaire using video clips obtained from the phantom administered to the raters for accuracy assessment. A, Normal lung sliding with A line. B, Limited lung sliding with lung pulse. C, Lung point of pneumothorax. D, Pulmonary edema with B lines. E, Pneumonia. F, Pleural effusion.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 Test Questions Administered to the Raters

References

Volpicelli G. .Elbarbary M. .Blaivas M. .et al International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577-591 [PubMed]journal. [CrossRef] [PubMed]
 
See K.C. .Ong V. .Wong S.H. .et al Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists. Intensive Care Med. 2016;42:63-71 [PubMed]journal. [CrossRef] [PubMed]
 
Rippey J. .Gawthrope I. . Creating thoracic phantoms for diagnostic and procedural ultrasound training. Australasian J Ultrasound Med. 2012;15:43-54 [PubMed]journal. [CrossRef]
 
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