The Ultrasound Phantom

A Teaching and Learning Tool

Dr Kristie TSANG
Department of Anesthesia and Intensive Care
The Chinese University of Hong Kong
Prince of Wales Hospital
Shatin
Hong Kong

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What is an Ultrasound Phantom?

Any material that simulates body tissue in its interaction
with ultrasound and which can be used to perform
simulated interventions.

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Why Use a Phantom?

Helps develop Hand-Eye coordination necessary for
ultrasound guided intervention
Allows one to perform simulated interventions without
having to do it for the first time in a patient
Helps develop confidence
Helps one to understand the factors that affect the visibility
of a needle during ultrasound guided interventions

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Commercially Available Phantom

e.g. Blue phantom
www.bluephantom.com

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The Blue Phantom

Sonographic Appearence

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Home-made Ultrasound Phantom

Tissue Mimicking Material
9 Agar based()
9 Gelatin based ()
9 Mixture of agar and gelatin
9 Chicken breast
9 Pork meat with porcine tendon embedded1
Targets
9 Latex tubing
9 Foley catheter
9 Wire
9 Cyst
9 Porcine tendon1
Housings
1: Xu D, et al. Ultrasound phantom for
hands-on practice. Reg Anesth Pain Med.
9 PVC lunch box
2005 Nov-Dec;30(6):593-4.

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Recipe for a Home Made Ultrasound Phantom

1) 3 table spoons of corn flour added to 200 ml of tap water
at room temperature. Gently stir until completely
dissolved
2) Then, add 3 table spoons of Gelatin powder and an
aditional 200 ml of near boiling water
3) Let the mixture cool down for 30 min before refrigerating
at 4 degree Celsius
4) Mixture will be ready for use in 10-12 hours time
9 Corn flour and gelatin are available at most
supermarkets

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Home-made Ultrasound Phantom

Made of an agar based material with a latex rubber tubing
embedded in it (to mimic a blood vessel)

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Agar Based Phantom

A resident practicing ultrasound guided vascular puncture

(hand-eye coordination) in the short axis using an agar
based phantom

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Blue Phantom

Practicing vasular puncture in the long axis using

a blue phantom

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Gelatin Based Phantom

A resident practicing interventional skills (visualizing the needle

in long axis) using a home made Gelatin based phantom

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Gelatin Based Phantom

A resident practicing interventional skills (visualizing the needle

in short axis) using a home made Gelatin based phantom

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Regional Anesthesia & Pain Medicine.2004; 29(6):544-8

10 inexperienced residents were asked to place a 22gauge needle into the exact midpoint of an olive buried
inside a turkey breast under ultrasound guidance.
The commonest error committed was the failure to
accurately image the needle while advancing which
resulted in excessive depth of penetration and inadvertent
transfixation of the olive.

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Reg Anesth Pain Med 2004;29:480-488

The shaft of the needle is better visible than the needle tip and
the visibility is better in the Long axis (LAX) than Short axis (SAX)
The Husted needle tip is subjectively better visibile than
the Tuohy and pencil-point needles
Larger outer diameter needles are better visible
Insulated needles are slightly more visible than non-insulated
needles
Stylet placement does not change needle tip visibility

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Reg Anesth Pain Med 2004;29:480-488

Needle tip and shaft visibility decreases gradually with steeper

angles. Shaft visibility decreases more sharply than tip visibility
The Needle tip is better visible in LAX when inserted at an angle
< 30 degrees
The Needle tip is better visible in SAX when inserted at an angle > 600
Air or water priming does not change needle visibility
Insertion of a guide wire enhances needle tip and shaft visibility

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Needle Visibility Effect of Needle Size

Tuohy needle 22-G, B Braun

Tuohy needle 16-G, Portex

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Needle Visibility Effect of Needle Type

Tuohy needle, 16-G

Echo-Coat needle, 25-G

Portex

STS Biopolymer Inc

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Needle Visibility Angle of Insertion

Tuohy needle 22G, B Braun

Needle inserted in LAX

Needle inserted prallel

to the foot print

Needle inserted at > 60

angle

Needle inserted at 30
angle

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Orientation and Measurement Excercise

Perform a transverse scan of the phantom to obtain a
cross- sectional view of the latex tubing (embedded in
the phantom)
Now rotate the scan head to visualize the transition from
cross-sectional to longitudinal view of the latex tubing
Use the electronic caliper to measure
1. The distance from the surface to the tubing
2. The diameter of the tubing

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Orientation and Measurement Excercise

Cross section of
the saline filled
latex tubing

Internal
diameter of the
latex tubing

Transverse Scan of Latex Tubing

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Orientation and Measurement Exercise

Longitudinal
view of latex
tubing

Wall thickness
0.12 cm

Internal diameter
0.5 cm
Longitudinal Scan of Latex Tubing

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Needling and Target Exercise

Perform a transverse scan to obtain a cross-sectional
view of the latex tubing embedded in the phantom
Now pass a needle in the long axis of the ultrasound
beam so as to position the tip of the needle at the 12
Oclock and 6 Oclock position of the tubing
Note that it is essential to visualize the tip of the needle
at all times and avoid passing through the tubing or
overshooting the target.

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Needling and Target Exercise

Needle tip at 12 oclock

position of the latex tubing

Needle inserted in the Long

Axis of the Ultrasound Beam

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Needling and Target Exercise

Needle inserted in the Long

Axis of the Ultrasound Beam

Needle tip at 6 oclock

position of the latex tubing

The Ultrasound Phantom

A Teaching and Learning Tool

Supported by

Ultrasound Guided Regional Anesthesia Workshop

Department of Anesthesia and Intensive Care
The Chinese University of Hong Kong
Prince of Wales Hsopital
Shatin, Hong Kong
Web link: http://www.aic.cuhk.edu.hk/Ultrasound Workshop/

Copyright: Department of Anesthesia and Intensive Care, CUHK