Experimental Research Article

Korean J Pain 2022; 35(4): 403-412

Published online October 1, 2022 https://doi.org/10.3344/kjp.2022.35.4.403

Copyright © The Korean Pain Society.

Development of pre-procedure virtual simulation for challenging interventional procedures: an experimental study with clinical application

Hyunyoung Seong , Daehun Yun , Kyung Seob Yoon , Ji Soo Kwak , Jae Chul Koh

Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea

Correspondence to:Jae Chul Koh
Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbukgu, Seoul 02841, Korea
Tel: +82-2-920-5632
Fax: +82-2-920-2275
E-mail: jaykoh@korea.ac.kr

Handling Editor: Jee Youn Moon

Author contributions: Hyunyoung Seong: Project administration; Daehun Yun: Writing/manuscript preparation; Kyung Seob Yoon: Writing/manuscript preparation; Ji Soo Kwak: Writing/manuscript preparation; Jae Chul Koh: Supervision.

Received: April 13, 2022; Revised: June 24, 2022; Accepted: July 12, 2022

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Most pain management techniques for challenging procedures are still performed under the guidance of the C-arm fluoroscope although it is sometimes difficult for even experienced clinicians to understand the modified three-dimensional anatomy as a two-dimensional X-ray image. To overcome these difficulties, the development of a virtual simulator may be helpful. Therefore, in this study, the authors developed a virtual simulator and presented its clinical application cases.
Methods: We developed a computer program to simulate the actual environment of the procedure. Computed tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data were used for the simulations. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, the authors searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified.
Results: For the simulations, the CT DICOM data of patients who visited the outpatient clinic was used. When the patients revisited the clinic, images similar to the simulated images were obtained by manipulating the C-arm. Transforaminal epidural injection, which was difficult to perform due to severe spinal deformity, and the challenging procedures of the superior hypogastric plexus block and Gasserian ganglion block, were successfully performed with the help of the simulation.
Conclusions: We created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.

Keywords: Computer-Assisted Instruction, Computer Simulation, Humans, Hypogastric Plexus, Injections, Epidural, Pain Management, Simulation Training, Tomography, X-Ray Computed, Trigeminal Ganglion, User-Computer Interface, Virtual Reality.