129 - Ultrasound-guided Injections in Soft-embalmed Cadavers: A Feasibility Study

Poster Board Number: 129
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Odd poster #s – first hour
Even poster #s – second hour

Abstract Body : Introduction
Ultrasound-guided (USG) injections have become common procedures in physical medicine and rehabilitation (PM&R) practices, but it remains difficult for novice learners to gain experience due to the invasive nature of injecting in living humans. Fresh frozen cadavers have been previously used to practice USG joint injections, but the same donor can only be used for a few days as tissue degrades rapidly after thawing. Soft-embalming techniques preserve cadavers for months while maintaining life-like flexibility and texture. It’s typically used to practice surgical procedures; its capacity to produce ultrasound images has not been explored. The purpose of this study is to evaluate the use of soft-embalmed cadavers as a model for learning USG joint injection.

Methods
We designed a single-session USG joint injection workshop for PM&R residents at the University of Manitoba. Two donor cadavers were soft embalmed using the Halifax protocol. Six residents performed USG injections to six sites: glenohumeral joint, subacromial-subdeltoid bursa, biceps tendon sheath, hip joint, greater trochanteric bursa, intra-articular knee joint. Following a demonstration of each injection by more experienced practitioners, residents were allowed to practice the injection as many times as they desired within the three-hour timeframe of the workshop. Residents were asked to complete surveys before and after the workshop to assess self-perceived benefit and provide feedback.

Results
All six injections sites in the soft-embalmed cadavers were visualized with ultrasound, generating images with sufficient levels of details for targeted injections. Needles were also readily observed and followed by the more experienced practitioners. All residents reported improved knowledge and confidence in each injection. Four out of six residents agreed that the soft-embalmed cadavers were an ideal substitution for living patients. Residents unanimous welcomed additional cadaver-based training in the PM&R program.

Conclusions and Significance
These data show the feasibility of a cadaver-based curriculum that allows PM&R trainees to develop USG injection skills using a soft-embalming technique that lasts longer than fresh frozen cadavers while maintaining physical properties for ultrasound imaging. This model of training can be further developed for other post-graduate medical programs to aid in ultrasound-guided procedures.