For COVID-19 vaccine updates, please review our information guide. For patient eligibility and scheduling availability, please visit

Virtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided Lumbar Puncture: A Pilot Study.

TitleVirtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided Lumbar Puncture: A Pilot Study.
Publication TypeJournal Article
Year of Publication2018
AuthorsAli S, Qandeel M, Ramakrishna R, Yang CW
JournalAcad Radiol
Date Published2018 02
KeywordsAdult, Feedback, Fellowships and Scholarships, Fluoroscopy, Humans, Imaging, Three-Dimensional, Internship and Residency, Pilot Projects, Proprioception, Radiology, Interventional, Simulation Training, Spinal Puncture, Tomography, X-Ray Computed, Touch, User-Computer Interface, Virtual Reality

RATIONALE AND OBJECTIVES: Fluoroscopy-guided lumbar puncture (FGLP) is a basic procedural component of radiology residency and neuroradiology fellowship training. Performance of the procedure with limited experience is associated with increased patient discomfort as well as increased radiation dose, puncture attempts, and complication rate. Simulation in health care is a developing field that has potential for enhancing procedural training. We demonstrate the design and utility of a virtual reality simulator for performing FGLP.

MATERIALS AND METHODS: An FGLP module was developed on an ImmersiveTouch platform, which digitally reproduces the procedural environment with a hologram-like projection. From computed tomography datasets of healthy adult spines, we constructed a 3-D model of the lumbar spine and overlying soft tissues. We assigned different physical characteristics to each tissue type, which the user can experience through haptic feedback while advancing a virtual spinal needle. Virtual fluoroscopy as well as 3-D images can be obtained for procedural planning and guidance. The number of puncture attempts, the distance to the target, the number of fluoroscopic shots, and the approximate radiation dose can be calculated. Preliminary data from users who participated in the simulation were obtained in a postsimulation survey.

RESULTS: All users found the simulation to be a realistic replication of the anatomy and procedure and would recommend to a colleague. On a scale of 1-5 (lowest to highest) rating the virtual simulator training overall, the mean score was 4.3 (range 3-5).

CONCLUSIONS: We describe the design of a virtual reality simulator for performing FGLP and present the initial experience with this new technique.

Alternate JournalAcad Radiol
PubMed ID29032887