Fluoroscopy-Guided Lumbar Puncture Training: Needs Assessment for Alternative Teaching Methods Including Simulation

A lumbar puncture (LP) is frequently performed to access the thecal sac for withdrawal of cerebrospinal fluid (CSF), most often for diagnostic analysis. Fluoroscopy-guided LP (FGLP) has gained popularity compared to traditional bedside LP, due to increasing patient obesity and associated lower rate of traumatic puncture due to fluoroscopic visualization of the needle. FGLP benefits patients with challenging spine anatomy or postoperative versus degenerative changes. To optimize the learning environment and decrease radiation exposure as well as inexperience-related errors, we conduct a needs assessment regarding current radiology resident FGLP didactics and consideration for alternative teaching methods.

An anonymous survey was administered to radiology residents at the University of Chicago (UC) and Northwestern University (NU) regarding didactics received prior to the trainee's first clinical FGLP. A total of 27 UC surveys were distributed, while there were 28 total at NU, with response rates of 85% and 71%, respectively. An initial pilot survey was conducted with three UC radiology residents who regularly assist with contrast simulation projects. Participant characteristics were as follows: UC: 34% female and 66% male, with an age range of 26 to 33 and ranging in postgraduate years 2 to 6; NU: 40% female and 60% male, with an age range of 25 to 35 and postgraduate training years 3 to 6. Participants were asked about the level of preparedness for the first and most recent FGLP attempt on a five-point Likert scale. The participants' level of satisfaction with current training methods was assessed to determine the desire for alternative training.

Five percent NU/0% UC survey participants were "extremely satisfied" with the current level of FGLP training, and 30% UC/20% NU students were "slightly satisfied." The majority of trainees (91% UC/80% NU) expressed interest in additional training, including virtual simulation and mannequin training.

Through this initial survey, we demonstrate the need for an alternative method for teaching FGLP to radiology trainees, with eagerness to explore further training by virtual methods or mannequin simulation.