see poster - Department of Radiology

Simulating Ultrasound Guided Biopsies in Ethiopia:
Tips, Tools, and Pitfalls
Anne Gill MD, Ryan Peterson MD, Patricia Hudgins MD FACR, Aarti Sekhar MD
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
Creating the Tissue Model
Global Health and Radiology: Emory-Black Lion Collaboration
Solid Lesions:
• Multiple incisions made into the beef livers with travel knife (3-inch blade)
• Kalamata olives were used to create the solid lesions
• Other organic matter to consider using are pimento filled olives
(would simulate a target-like hepatic lesions)
• Artifact: air induced while placing olive into the incision
Emory University has a long-standing collaboration with Black Lion Hospital (BLH), Ethiopia’s 800-bed teaching
hospital and major referral center for the country of 85 million people.
With the help of faculty at Emory University, the Department of Radiology at Black Lion hospital was the first to
pioneer image guided procedures in the country. Despite this great accomplishment, image guided procedures
are only performed by trained faculty and residents rarely have the opportunity to participate. Therefore, in order
to enhance resident training, the Department of Radiology and Imaging Sciences at Emory University developed
a tissue simulation model to train the Black Lion Radiology residents to perform routine targeted ultrasound
guided liver biopsies and cyst aspirations.
Cystic Lesions:
• Multiple incisions made into the beef livers with travel knife (3-inch blade)
• Non-sterile glove filled with water
• Finger compartments tied off and removed
• Artifact: air induced while placing fluid filled object into the incision
Spectrum of Disease
Simulation Experience
Ethiopia has diseases common to developing nations, such as malnutrition and infectious diseases (including
tuberculosis, HIV, malaria), as well as an increasing prevalence of pathology traditionally more common in the
first world, such as cardiovascular disease, cancer, and motor vehicle accident injuries.
A total of 12 residents volunteered to participate in the hands-on and didactic training.
Each participant completed the educational module and performed the biopsy/cyst aspiration successfully.
Feedback from the residents and faculty were positive.
Accurate diagnosis and staging of cancer is essential in improving survival rates; however, the radiographic
appearance of various infectious and malignant hepatic pathologies can be nonspecific and histological
diagnosis is frequently required to determine patient treatment and prognosis.
Following the training, information on how to set up the tissue model was requested from the chief residents
from Black Lion Hospital and plans are being made for future training sessions for other residents.
Ultrasound-guided FNA
Ultrasound is widely available in Ethiopia, even in the more rural areas where most graduating radiology residents
will practice for at least two to three years. US guided-FNA is a safe and effective procedure for tissue diagnosis.
Attending radiologists in Ethiopia routinely performs US guided procedures, but there is no formal training program/
rotation for the trainees. This represents a significant gap in resident education.
After assessing the interest level from the residents, a training module highlighting the safety, patient selection, and
procedural technique was created. A short, didactic lecture was given before the procedural practice session. The
residents were given the lecture slides for reference and in hopes of continuing the training module once the
Emory Radiology residents left.
Demonstration
Demonstration of needle positioning
using US guidance
Using Local Resources and Equipment
Local Equipment:
Ultrasound machine
High resolution linear US probe
Conclusions
Local Supplies Purchased:
FNA needle: 20-25g needle (10)
Beef Liver specimens
Plastic Containers
Non Sterile Exam Gloves
Olives
Total
180 Birr
235 Birr
238 Birr
120 Birr
85 Birr
858 Birr (= $47.00)
Estimated Cost for Patient:
Sterile gloves, 2 pairs
Lidocaine, 30 ml vial
Three 10 ml syringes
Total
14 Birr
19 Birr
255 Birr
288 Birr (= $16.39)
It is feasible to successfully train residents using tissue models for US-guided FNA. US-guided FNA biopsies
and cyst aspirations are a reasonable diagnostic method for indeterminate hepatic lesions. This skill has the
potential to obviate the need for unnecessary invasive surgical procedures and expedite diagnosis in a safe and
economical manner.
Our goal is to maintain this partnership with BLH and continue a meaningful bidirectional educational experience
while providing high quality health care services in the Radiology Department. Potential future endeavors
include re-evaluating the resident skill level on tissue models (with pre and post test surveys, timed trials to
locate and biopsy the lesion, and incorporation of core biopsy techniques). The ultimate goal is for a resident to
perform the diagnostic ultrasound and US guided biopsy on a patient with faculty supervision.

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