Learning curve of radiology residents during training in fluoroscopy-guided facet joint injections

Dias, Tiago Rocha; Alves, João de Deus da Costa; Abdala, Nitamar

doi:10.1590/0100-3984.2015.0176

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Sumário

ORIGINAL ARTICLES • Radiol Bras 50 (3) • May-Jun 2017 • https://doi.org/10.1590/0100-3984.2015.0176 copy

Learning curve of radiology residents during training in fluoroscopy-guided facet joint injections

Curva de aprendizado de residentes em radiologia durante treinamento em punção de articulações facetárias guiada por fluoroscopia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To develop a simulator for training in fluoroscopy-guided facet joint injections and to evaluate the learning curve for this procedure among radiology residents.

Materials and Methods:

Using a human lumbar spine as a model, we manufactured five lumbar vertebrae made of methacrylate and plaster. These vertebrae were assembled in order to create an anatomical model of the lumbar spine. We used a silicon casing to simulate the paravertebral muscles. The model was placed into the trunk of a plastic mannequin. From a group of radiology residents, we recruited 12 volunteers. During simulation-based training sessions, each student carried out 16 lumbar facet injections. We used three parameters to assess the learning curves: procedure time; fluoroscopy time; and quality of the procedure, as defined by the positioning of the needle.

Results:

During the training, the learning curves of all the students showed improvement in terms of the procedure and fluoroscopy times. The quality of the procedure parameter also showed improvement, as evidenced by a decrease in the number of inappropriate injections.

Conclusion:

We present a simple, inexpensive simulation model for training in facet joint injections. The learning curves of our trainees using the simulator showed improvement in all of the parameters assessed.

Keywords:
Zygapophyseal joint; Injections, intra-articular; Injections, spinal; Learning curve; Models, anatomic; Radiology, interventional

	Time estimated for the first injection, in seconds		Slope of the curve		Quality of the adjustment
Volunteer	α	Standard error	β	Standard error	R²	Learning rate
1	456.7	86.7	–0.38*	0.09	0.579	81.6%
2	362.2	51.4	–0.36*	0.07	0.683	77.9%
3	407.8	62.2	–0.46*	0.07	0.737	72.7%
4	254.2	46.1	–0.31†	0.09	0.484	80.7%
5	182.8	20.0	–0.27*	0.05	0.650	82.9%
6	163.1	17.8	–0.20†	0.05	0.524	87.1%
7	165.0	16.2	–0.30*	0.05	0.740	81.2%
8	179.0	17.5	–0.38*	0.05	0.821	76.8%
9	156.0	16.7	–0.33*	0.05	0.743	79.6%
10	171.8	17.2	–0.39*	0.05	0.822	76.3%
11	210.7	38.8	–0.48*	0.09	0.677	71.7%
12	176.5	16.2	–0.43*	0.05	0.873	74.2%
Mean	240.48		–0.36		0.69	78.16%
Standard deviation	106.76		0.08		0.12	4.41%
Coefficient of variation	44.4%		22.6%		17.3%	5.6%

	Fluoroscopy time estimated for the first injection		Slope of the curve		Quality of the adjustment
Volunteer	α	Standard error	β	Standard error	R²	Learning rate
1	2.999	0.802	-0.293	0.124	0.283	81.6%
2	1.862	0.441	-0.335^* * p ≤ 0.05,	0.114	0.397	79.3%
3	1.640	0.299	-0.308^† † p ≤ 0.01 and	0.088	0.465	80.8%
4	1.315	0.415	-0.319	0.153	0.250	80.2%
5	1.086	0.187	-0.262^† † p ≤ 0.01 and	0.083	0.413	83.4%
6	0.818	0.192	-0.253^* * p ≤ 0.05,	0.113	0.262	83.9%
7	1.215	0.185	-0.374^‡ ‡ p ≤ 0.001 for the hypothesis β = 0.	0.074	0.648	77.2%
8	1.088	0.153	-0.354^‡ ‡ p ≤ 0.001 for the hypothesis β = 0.	0.068	0.657	78.2%
9	0.898	0.102	-0.359^‡ ‡ p ≤ 0.001 for the hypothesis β = 0.	0.055	0.754	78.0%
10	1.165	0.113	-0.355^‡ ‡ p ≤ 0.001 for the hypothesis β = 0.	0.047	0.803	78.2%
11	1.494	0.254	-0.545^‡ ‡ p ≤ 0.001 for the hypothesis β = 0.	0.082	0.757	68.5%
12	0.942	0.087	-0.362^‡ ‡ p ≤ 0.001 for the hypothesis β = 0.	0.045	0.824	77.8%
Mean	1.38		-0.34		0.54	78.9%
Standard deviation	0.60		0.07		0.22	3.9%
Coefficient of variation	43.38%		21.81%		40.73%	5.0%

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[1] Mailing address: Dr. Nitamar Abdala. Departamento de Diagnóstico por Imagem - EPM-Unifesp. Rua Napoleão de Barros, 800, Vila Clementino. São Paulo, SP, Brazil, 04024-002. E-mail: nitamar.ddi@epm.br.