UTILIZING UNFIXED CADAVERS IN MEDICAL STUDENT ULTRASOUND TRAINING FOR NORMAL SCROTAL ANATOMY

Abstract

Point-of-care ultrasound (POCUS) continues to become more widespread due to its range of use, low cost, and extremely high level of patient safety. It is imperative that we train medical professionals to utilize this tool in its fullest capacity as its diagnostic accuracy varies drastically with the skill and experience of the provider. Many programs recognize this discrepancy and have begun implementing POCUS earlier in training within medical school curricula. Despite these efforts, training across the broad application of POCUS continues to be underutilized in anatomy that is less accessible due to reservation amongst peers and patients. Testicular and scrotal anatomy is one of these sensitive areas that is lacking in early hands-on training. Ultrasound remains the first-line modality in the evaluation of scrotal disease. For emergent etiologies of acute scrotal pain or swelling, timing largely determines prognosis; any delay in care significantly increases risk of tissue necrosis, compromising the fertility of the patient. A solid foundation in acquiring and visualizing normal scrotal anatomy on the human body is an essential first step in creating the adept POCUS provider. Utilizing fresh, unfixed cadavers as ultrasound screening specimens for scrotal anatomy may be a feasible option for initiating early training in scrotal POCUS. Supported by the Willed Body Program, cadavers were screened with hand-held Butterfly iQ+ ultrasound devices by members of the ultrasound teaching assistant cohort of 3rd and 4th year TCOM students. Ultrasound acquired images and clips were reviewed and evaluated by a trained faculty member. Of the images obtained 17 out of 20 cadavers (85%) adequately visualized pertinent structures of scrotal anatomy in the absence of significant imaging artifacts. The Butterfly iQ+ ultrasound provided excellent quality images with minimal artifacts; the scrotum is an easily accessible organ that avoids the early processes of decomposition which can obscure image acquisition. However, given the lack of blood flow, color and power doppler settings were unable to be adequately utilized. These settings are crucial in the diagnosis of certain scrotal pathologies such as epididymitis, varicocele, testicular torsion and orchitis. In conclusion, the provider's first time obtaining and assessing scrotal anatomy on a human body should not be in a time-limited, emergent situation. Fresh, unfixed cadavers can provide a means for closing the gap in providing scrotal anatomy training at the medical school level and ultimately elevate patient care. Benefits to this approach include: increased diagnostic and visualization skills of normal structures, augmented visuo-spatial and tactile probe-handling skills, enhanced ability to compensate for artifact and variations in anatomy, and practice handling the patient with professionalism and care. Future projects could include using cadavers to artificially replicate pathologic conditions for advanced training in diagnostic and procedural skills.