Model Kidney Created for Simulated Ultrasound-guided Biopsy

The model is halfway completed. A pig kidney and simulated rib are set in gelatin. More gelatin and a silicone “skin” finish the model. In the Division of Nephrology at The Children’s Hospital of Philadelphia, physicians perform approximately 60 to 70 ultrasound-guided renal biopsies a year. Depending on their patient population, some physicians do them less regularly, and new fellows always need practical training.

To accommodate those needs, Sonal Bhatnagar, MBBS, and Kevin E. Meyers, MBBCh, working with Grace Good, MA, BSN, RN, of CHOP’s Center for Simulation, Advanced Education and Innovation, created a gelatin and silicone simulated kidney training model.

“Most people follow the ‘watch one, do one’ model of learning on the job,” Bhatnagar says. “Our research found that few, if any, pediatric hospitals, had training models. We decided to create our own.”

Their early “recipe” was drawn from a 2013 article in Clinical Nephrology written by nephrologists from Liverpool, UK. Bhatnagar and Good experimented with the density of the gelatin and the concentrations of aluminum oxide and silicon carbide particles until the model had the look and feel of human tissue when probed with the ultrasound wand and biopsy needle. Silicone was used to simulate skin. Once the recipe was created, a harvested pig kidney and simulated rib were inserted in the model.

Attending physicians and fellows participated in the first training session in September 2014.

“We received a very good response from everyone who attended,” Bhatnagar says. Because it can be tricky to coordinate guiding the US wand with one hand and the biopsy gun with the other, “fellows benefitted more, especially those in the early part of their training. But the attendings appreciated a chance to brush up on their skills, too.”

Plans call for a repeat training session for each new class of fellows. Sessions will be open to the entire division.