Abstract
Objectives: Intussusception, an uncommon but important cause of acute abdomen during infancy and early childhood, can be safely and effectively treated by fluoroscopic air reduction. Although pediatric radiology fellows report ample opportunity to practice intussusception reduction, radiology residents report few opportunities to participate in this procedure. Adequate training to reduce intussusception is essential, as successful reduction obviates the need for surgery. A teaching device that simulates intussusception reduction could help radiology residents develop the skills necessary to perform this procedure. Materials and Methods: We report on improvements made to a training device developed in 2010 by Stein-Wexler et al. Since then we have simplified the manufacturing process, added several unique patient cases, improved the software so that adding patient scenarios is easier, and improved the graphic interface to make the simulation more realistic and facilitate feedback. Results: The simulator is now a customizable and robust standalone package. A thorough instructor’s manual and improvements to the graphic design-such as embedded checklists, built-in feedback mechanisms, and a more intuitive interface-make the simulator easier to use. Conclusion: We have improved our previously-reported teaching device for intussusception reduction and produced a robust simulator. We plan to make this device available to programs that train physicians in pneumatic intussusception reduction.
Highlights
Intussusception is an uncommon but important factor to consider in pediatric cases of acute abdomen
A survey found that senior radiology residents on average reported participating in only 2 cases during their entire residency; 22% had been involved in no reductions, and 21% had been involved only once [5]
A more recent survey found that pediatric radiology fellows have more experience with reducing intussusception, with respondents reporting an average of 6.9 reductions [6]
Summary
Intussusception is an uncommon but important factor to consider in pediatric cases of acute abdomen. First-line treatment for pediatric intussusception is enema reduction under the supervision of a radiologist. Both air and liquid enemas have been shown to be effective and safe [3], but air reduction is more likely to result in a successful reduction, causes less radiation exposure, and causes less peritoneal contamination in the event of perforation [4]. A more recent survey found that pediatric radiology fellows have more experience with reducing intussusception, with respondents reporting an average of 6.9 reductions [6]. Meyer et al [7] demonstrated that a radiologist must participate in at least 4 to 6 reductions to gain sufficient skill and confidence in this technique; by these criteria, the typical pediatric radiology fellow receives adequate training in intussusception reduction, but the typical radiology resident does not
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