Animal tissue phantom for training in ultrasound guided

interventional procedures

Poster No.: C-0519

Congress: ECR 2017
Type: Educational Exhibit
Authors: 1 1 2
A. Charokopakis , A. Anagnostopoulou , C. Iosifidis , E. Antypa ,
1

1 1 2
P. N. Piperopoulos ; Athens/GR, Argyroupoli/GR
Keywords: Biopsy, Ultrasound, Interventional vascular, Interventional non-
vascular, Puncture, Education and training
DOI: 10.1594/ecr2017/C-0519

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Learning objectives

To demonstrate the use of an animal tissue phantom for training purposes on ultrasound-
guided interventional procedures.

Background

Interventional procedures are routinely performed in ultrasound departments. Although

minimally invasive they are not free from complications. As with any ultrasound study
operator experience plays an important part. A common issue is how to familiarize an
inexperienced user with such procedures, while minimizing potential risk for the patient.

Findings and procedure details

We present the use of two animal phantoms (turkey and porcine) to familiarize
inexperienced operators with ultrasound guided interventional procedures. We find the
echogenicity and texture of animal tissue quite similar to human tissue (Fig.1). We use
grapes as target lesions implanted through small incisions. They are well demarcated
on ultrasound due to the presence of a thin layer of interposing air (Fig.2). Covering the
grapes with a small amount of ultrasound gel allows for better visualization of the lesions
(Fig.3). After embedding the target lesions, the specimen is wrapped with cling film.
Caution is needed so that no air is trapped between the film and the tissue, as this would
greatly hinder visualization. This is a step that improves the stability of the specimen.

Gelatin and agar phantoms have been described [1].They are of low cost and, as
cast materials they offer the possibility of building quite complex structures which can
be useful in more advanced techniques, such as anatomical obstacle avoidance and
hydro-dissection. However, we find that the necessary preparation time, which has been
reported to be as high as 12 hours, is highly impractical considering the workload of
our department. Additionally, since the cornerstone of any successful ultrasound guided
procedure, is accurate initial needle placement, we believe that the focus of training
should be targeted primarily on that aspect. Commonly performed procedures in our
department are thyroid nodule FNA, solid tumors FNB and percutaneous drainage of
fluid collections.

Animal tissue phantoms, although a bit costlier than gelatin and agar, have the advantage
of requiring much less preparation both in time and in effort and also are closer in texture
and feel to human tissue. They are also much more easily accessible compared to

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gelatin and agar. We find turkey legs suitable for training with more superficial lesions
and structures, while porcine phantoms can accommodate deeper lesions. There are
limitations however in terms of complexity and these phantoms are better suited for
developing basic skills required for ultrasound guided interventional procedures. Another
aspect of the training is familiarizing the trainee with the most commonly used needles
in our practice (standard bevel 21G and 16G needles, commonly used in thyroid nodule
FNA (Fig.4, Fig.8, Fig.9) and percutaneous drainage respectively, Franseen needles with
various gauges, used in solid, fibrotic tumors (Fig.5, Fig.6) and tru-cut needles used in
solid tumors biopsy(Fig.7, Fig.10, Fig.11)).

Two issues have been raised, concerning the risk of infection and political/animal rights
issues. We address the risk of infection with the use of plastic containers for placing the
specimens and vinyl/latex gloves for handling them. All ultrasound probes are covered
with a latex glove during training sessions and we use disinfectants for all the equipment
routinely. Although the ethical issue is of some concern, animal tissue phantoms are a
well established alternative to commercially available phantoms [2,3].

Images for this section:

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Fig. 1: Image showing the echotexture of a turkey phantom with a linear probe in virtual
convex mode

A. Charokopakis, Athens/GR

Fig. 2: Embedded lesion showing highly echogenic rim due to the presence of interposing
air

A. Charokopakis, Athens/GR

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Fig. 3: Better visualization, in longitudinal and transverse images, of an embedded lesion
after the application of a small amount of ultrasound gel prior to insertion.

A. Charokopakis, Athens/GR

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Fig. 4: Bevel orientantion in a turkey phantom

A. Charokopakis, Athens/GR

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Fig. 5: Franseen needle in a porcine phantom. Note the highly echogenic tip (arrow)

A. Charokopakis, Athens/GR

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Fig. 6: Franseen needle in a turkey phantom. As in Fig.5 the echogenic tip is clearly
visualized

A. Charokopakis, Athens/GR

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Fig. 7: Tru cut needle in a porcine phantom. Convex probe is used

A. Charokopakis, Athens/GR

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Fig. 8: Paracentesis of a superficial lesion in a porcine phantom with a standard bevel
21G needle mounted on a 20ml syringe

A. Charokopakis, Athens/GR

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Fig. 9: Video demonstrating the "back and forth" motion commonly used in FNA
procedures

A. Charokopakis, Athens/GR

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Fig. 10: Video demonstrating angle correction and needle advancement towards the
embedded lesion

A. Charokopakis, Athens/GR

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Fig. 11: After the needle reaches the lesion, the notched stylet is deployed, then the
sample is taken and the needle is withdrawn

A. Charokopakis, Athens/GR

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Conclusion

We find that animal tissue phantoms are an invaluable tool in introducing residents to
ultrasound guided interventional procedures in terms of developing needle-transducer
coordination and perhaps even more importantly confidence. We therefore strongly
encourage the use of phantoms as an introductory method to ultrasound guided
interventional techniques.

Personal information

References

1. Phantoms for training ultrasound guided procedures - importance of simulation and

low-cost alternatives. F. M. G. S. Pereira da Silva, H. Donato, S. J. Mota, P. Donato, F.
Caseiro Alves, ECR 2015, DOI: 10.1594/ecr2015/C-2226

2. A tissue phantom model for training residents in ultrasound-guided liver biopsy.

Sekhar A., Sun MR., Siewert B., Acad Radiol. 2014 Jul;21(7):902-8. DOI: 10.1016/
j.acra.2014.03.002.

3. Simulators for training in ultrasound guided procedures Syed Farjad Sultan, George
Shorten, Gabriella Iohom, Med Ultrason 2013, Vol. 15, no. 2, 125-131 DOI: 10.11152/
mu.2013.2066.152.sfs1gs2

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