900 Section - A Versatile 3D-Printed Lumbar Spine Phantom for Dual-Modality Training in Fluoroscopy and Ultrasound-Guided Procedures

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

BB

Bruno A. Bermudes, MD

PMR physician
Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade da Universidade de Sao Paulo, Sao Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
CN

Caio MD Neiva, MD

PM&R physician
Faculdade de Medicina da Universidade de São Paulo (FMUSP)
São Paulo, Sao Paulo, Brazil
André T. Tadeu Sugawara, PhD

Professor Doutor de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação
Universidade de São Paulo. Faculdade de Medicina
São Paulo, Sao Paulo, Brazil

Co-Author/Coautor(s)

DT

Daniel SU Tamashiro, n/a

Researcher
Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade da Universidade de Sao Paulo, Sao Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
OA

Osmar de Lima Alves, n/a

Researcher
Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade da Universidade de Sao Paulo, Sao Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
LB

Linamara R. Battistella, MD, PhD

Full Professor
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
RR

Roberto A. Rached, MD

PMR physician
Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade da Universidade de Sao Paulo, Sao Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil

Objectives : To develop a cost-effective, patient-derived, lumbar spine phantom that is both sonopaque and radiopaque, enabling integrated training in ultrasound and fluoroscopic procedures.

Design: De-identified patient lumbar spine computed tomography scan DICOM data were segmented using the software InVesalius with manual refinement of anatomical structures to obtain stereolithography data of the L2, L3 and L4 vertebrae. The segmented mesh was optimized in the software Autodesk MeshMixer for geometry correction and structural integrity. Vertebrae were 3D-printed in Creality K1Max printer using PLA Stone filament to maximize radiopacity. The phantom consisted of printed vertebrae mounted within a patient-derived lumbar mold in thermoplastic, embedded in homemade ballistic gelatin, made from colorless unflavored gelatin and vegetable glycerin, within a rigid container. The phantom was assessed using C-arm fluoroscopy and ultrasound imaging and the results were compared to those obtained from a human subject.

Results:
The phantom demonstrated consistent radiopacity and sonopacity, with clear delineation of vertebral anatomy across imaging planes. It enabled realistic simulation of needle advancement and targeting for medial branch, facet, and selective nerve root injections. The model also reliably replicated the surface anatomy of the lumbar region. Because the model focuses solely on bony structures, the absence of soft tissue simulation represents a limitation primarily for ultrasound training. However, this is not a limitation for fluoroscopic procedures, which rely exclusively on osseous landmarks. The ballistic gelatin provided tactile resistance comparable to general muscle firmness, although it does not reproduce the layered composition of human tissues. During ultrasound use, needle passages traps small amounts of air, creating reverberation artifacts.

Conclusion:
This patient-specific phantom represents a practical, low-cost training alternative that maintains anatomical accuracy while supporting both Fluoroscopy and Ultrasound procedural simulation. Its reproducible workflow and accessibility make it suitable for integration into residency training programs and procedural skills laboratories.