Simulation of fluoroscopic-guided lumbar puncture with a novel spine task trainer.

Abstract

Lumbar puncture is a frequently performed procedure for a variety of indications including withdrawal of cerebrospinal fluid for laboratory analysis, intracranial pressure assessment, administration of intrathecal therapeutic agents and myelography. Typically, this procedure is first attempted at bedside, and if unsuccessful, radiologists are requested to perform it under fluoroscopic guidance. As fluoroscopic-guided lumbar puncture (FGLP) requests are common, proficiency is required for general radiology and neuroradiology trainees. Pain physicians from speciality backgrounds including anesthesiology, neurology and physical medicine and rehabilitation also receive training in similar fluoroscopic-guided spinal procedures. The use of fluoroscopy in guiding spinal procedures can be challenging to a new learner as it requires integration of anatomy and procedural technique while attempting to minimise fluoroscopy times and radiation dosage; the importance of the latter is indicated by data revealing medical radiation’s contribution of almost half of the American population’s average annual radiation exposure.1 The procedure is traditionally taught on actual patients who are awake, aware and without sedation. Unfamiliarity of a new learner with the procedure can lead to undue patient anxiety, pain and increased radiation dose, as well as increased stress on the learner.2,3 The ability to train for this procedure …