Creation of an optic nerve sheath diameter ultrasound model for NeuroICU education

Heidi M Felix,Jason L Siegel,Robert A Pooley,William D Freeman,Amy M Lannen,Kristin A Rosenbush,Christina I Collins,Melissa L Mcmullan,Benjamin L Brown

doi:10.1186/s40779-020-00274-4

Abstract

BackgroundUsing ultrasound to measure optic nerve sheath diameter (ONSD) is an emerging bedside technique to noninvasively assess intracranial pressure (ICP) in patients with brain injury. This technique is unique among bedside ultrasonography and is often performed by providers who have no formal ultrasound training. We sought to create a low-cost, 3D, reusable ONSD model to train neurology, neurosurgery, and critical care providers in measuring ICP.ResultsWe identified 253 articles, of which 15 were associated with models and 2 with simulation. One gelatin model was reported, upon which we based our initial design. We could not validate the visual findings of this model; however, after constructing multiple beta models, the design most representative of human eye anatomy was a globe made of ballistics gel and either a 3 mm, 5 mm, or 7 mm × 50 mm 3D-printed optic nerve inserted into a platform composed of ballistics gel, all of which sat inside a 3D-printed skull. This model was used to teach ONSD measurements with ultrasound at a continuing medical education event prior to training on a live human model.ConclusionA simple 3D ballistic ONSD model allows learners to practice proper hand placement and pressure, basic landmarks, and ONSD measurement prior to operating on a human eye. This model is replicable and sustainable given that the globe and platform are composed of ballistics gel.

Highlights

Using ultrasound to measure optic nerve sheath diameter (ONSD) is an emerging bedside technique to noninvasively assess intracranial pressure (ICP) in patients with brain injury
Our objectives were to produce an ONSD model that was anatomically accurate when viewed by ultrasound, to implement a task trainer for measuring ONSD and to evaluate the ease of use for implementing this model in the training of neurology, neurosurgery, and critical care advanced practice providers and physicians
Before embarking on our own mold creation process, commercially available molds were explored, but these products were too large, had seams that showed on ultrasound, or were too difficult to fill with the gel

Summary

Introduction

Using ultrasound to measure optic nerve sheath diameter (ONSD) is an emerging bedside technique to noninvasively assess intracranial pressure (ICP) in patients with brain injury. This technique is unique among bedside ultrasonography and is often performed by providers who have no formal ultrasound training. We sought to create a low-cost, 3D, reusable ONSD model to train neurology, neurosurgery, and critical care providers in measuring ICP. Measuring optic nerve sheath diameter (ONSD) with point-of-care ultrasound is an emerging technique to noninvasively assess intracranial pressure (ICP) in patients with brain injury. Hassen et al [10] found a similar correlation between computed tomography measurements of ONSDs and ultrasound. As with many procedures, creating a simulation or task trainer is preferred before

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