Methodological study on constructing a liver phantom for training in transjugular intrahepatic portal shunt training

doi:10.3877/cma.j.issn.2095-5782.2025.01.012

Abstract

Abstract:

Objective

Exploring the methodological elements of constructing a liver phantom for training transjugular intrahepatic portal systemic shunt （TIPS） in a real interventional procedure environment.

Methods

A retrospective analysis was conducted on the DSA image data of 36 patients treated with TIPS in our hospital.Three typical cases' enhanced CT thin-layer data were selected as the master version.Mimics software and 3D MAX software were used to extract， reconstruct， and smooth the models of hepatic vein，portal vein， inferior vena cava， and liver.The connection model between portal vein and hepatic vein and the mold model were established.The hardness of silicone blocks with different Shore hardness was tested by needle puncture.After 3D printing the above model， and the silicone for simulating hardened liver was injected for molding and demolding operations.The pipeline path was established according to the principle of blood circulation and connected to the liver silicone model and submersible pump.CT scanning and TIPS simulation training under digital subtraction angiography （DSA） were performed on the model to evaluate its reliability and realism.

Results

The key elements of this study included the three-dimensional modeling of small-diameter connecting pipes and mold molds for portal vein branches and hepatic vein branches， as well as the demolding operation of the molds.Silicone with a Shore hardness of 10° could simulate liver with heavier hardening， while silicone with a Shore hardness of 5° could simulate liver with lighter hardening.The CT images of the model could achieve path planning for portal vein puncture from the hepatic vein，and the internal and various interfaces of the model showed good anti-leakage characteristics.The hepatic vein and portal vein imaging were similar to real procedure， and the liver puncture process had realistic resistance feedback.

Conclusion

The construction of a liver phantom containing hepatic veins and portal veins is technically feasible， with high reliability and realism， and can be used for TIPS simulation training of interventional physicians.

Key words: Transjugular intrahepatic portosystemic shunt, Model, Three-dimensional reconstruction, Simulation

Lin Qi, Ting Hong, Xin Wei, Hong Hu, Jiaqi Pu, Yunguo Liao, Xing Deng, Chao Li, Dan Deng, ZiYu Tang, Zhipeng Feng, Shixiang Qiu. Methodological study on constructing a liver phantom for training in transjugular intrahepatic portal shunt training[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(01): 62-67.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2025.01.012

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Figures/Tables 6

References 10

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观察点	接通流体循环TIPS模拟前	接通流体循环TIPS模拟中
血管接口自然渗漏	无	无
颈内静脉穿刺点渗漏	无	无
肝静脉穿刺点渗漏	无	无
门静脉穿刺点渗漏	无	无
模拟肝表面渗漏	无	有
模拟血流不稳定或中断	无	无
重复模拟操作不能实现	无	无

观察点	接通流体循环TIPS模拟前	接通流体循环TIPS模拟中
血管接口自然渗漏	无	无
颈内静脉穿刺点渗漏	无	无
肝静脉穿刺点渗漏	无	无
门静脉穿刺点渗漏	无	无
模拟肝表面渗漏	无	有
模拟血流不稳定或中断	无	无
重复模拟操作不能实现	无	无

观察点	高级职称组平均分	中级职称组平均分	初级职称组平均分	规培医师组平均分
颈内静脉穿刺阻力反馈	4.5	4.0	4.0	4.0
血管内插管流畅度	4.5	4.2	4.0	4.3
肝静脉造影影像	4.0	4.2	4.5	4.3
模拟肝脏穿刺阻力反馈	4.5	4.2	4.0	4.0
门静脉造影影像	4.0	4.2	4.0	4.3

观察点	高级职称组平均分	中级职称组平均分	初级职称组平均分	规培医师组平均分
颈内静脉穿刺阻力反馈	4.5	4.0	4.0	4.0
血管内插管流畅度	4.5	4.2	4.0	4.3
肝静脉造影影像	4.0	4.2	4.5	4.3
模拟肝脏穿刺阻力反馈	4.5	4.2	4.0	4.0
门静脉造影影像	4.0	4.2	4.0	4.3

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