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Published on: August 9, 2024
Ultrasound-Guided Foreign Body Removal: Simulation Training and Clinical Implementation Outcomes
Megan Buras1, Carmen Campbell2, J Matthew Meadows3
1Department of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
Introduction:
High-resolution ultrasound can be utilized for the detection, localization, and characterization of both radiopaque and non-radiopaque soft tissue foreign bodies. However, ultrasonography as an intraoperative or percutaneous guidance method has not been systematically described in military-related wound management. The purpose of this study is to determine if ultrasound-guided foreign body removal (USFBR) taught in simulation improves radiologist technique and Foreign Body (FB) removal outcomes. Once the technique is mastered, the implementation of FB removals in Department of Defense (DoD) beneficiaries is studied.
Materials And Methods:
In this 2-phase study, USFBR simulation training was taught to 47 radiologists at 4 military treatment facilities over a 2-year period. Radiologists were assessed on FB removal techniques before and after 4 hours of individual hands-on training by a teaching team of 4 radiologists experienced in the technique. In the second phase of this study, clinical implementation of USFBR was documented on DoD beneficiaries. Institutional approval for each phase was obtained from the Internal Review Board of Nationwide Children's Hospital and National Navy Medical Center, Brooke Army Medical Center, Madigan Army Medical Center, and Tripler Army Medical Center review boards.
Results:
Phase 1 training study demonstrated that the USFBR simulation training improved radiologists' scores from 21-52% pre-training to 90-100% post-training (P < .01 for each test component). Phase 2 clinical implementation demonstrated a 90% successful removal rate as defined by the complete removal of the FB from a DoD beneficiary under ultrasound guidance by a trained radiologist.
Conclusions:
This study confirms that radiologists who complete simulation training can remove embedded FBs employing ultrasound imaging. Implementation of focused hands-on simulation training programs has the potential to improve ultrasonographic FB management practice. Implementation by trained radiologists was successful in removing FBs from DoD beneficiaries.
