Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Engineering Science


Biomedical Engineering


Peters, Terry. M.

2nd Supervisor

Eagleson, Roy



Percutaneous renal access (PCA) is a critical step in needle-based renal procedures. Traditional PCA training relies on apprenticeship, which raises concerns about patient safety and limits training opportunities. In this thesis, we reviewed simulation-based training for PCA, described the development of a novel augmented reality (AR) simulator for ultrasound (US)-guided PCA, and evaluated its validity and efficacy as a teaching tool.

Our AR simulator allows the user to practice PCA on a silicone phantom using a tracked needle and US probe emulator under the guidance of simulated US on a tablet screen. 6 Expert and 24 novice participants were recruited to evaluate the efficacy of our simulator.

Experts highly rated the realism and usefulness of our simulator, reflected by the average face validity score of 4.39 and content validity score of 4.53 on a 5-point Likert scale. Comparisons with a Mann-Whitney U test revealed significant differences (p

Our cost-effective, flexible, and easily customizable AR training simulator can provide opportunities for trainees to acquire basic skills of US-guided PCA in a safe and stress-free environment. The effectiveness of our simulator is demonstrated through strong face, content, and construct validity, indicating its value as a novel training tool.

Summary for Lay Audience

Percutaneous renal access (PCA) is the initial step to gain access to the kidney for treating common kidney diseases such as kidney stones. At present, mastering of this technique relies on extensive clinical training. However, it is very challenging to keep up with the increasing training demand for many training centres. To lessen the burden of the clinical education and deliver safer patient care, training simulators were employed to provide supplementary training opportunities. This thesis reviewed the existing training simulators for PCA and found no AR/VR simulator available for ultrasound (US)-guided PCA, which is a safer alternative to fluoroscopy (FL)-guided PCA. Therefore, the goal of this work was to develop and validate a training simulator for US-guided PCA.

Following a minimalism design approach, we integrated 3D printed hardware components, an easy-to-make silicone phantom, and personal mobile device to build an low-cost training simulator for US-guided PCA. Since the surgical scene, including the kidney and US images are simulated and visualized in AR, the tradition lab setting is no longer required. Trainees have the option to practice at home in a stress-free environment. In addition, this simulator provides performance feedback via direct visualization and data sheet, which facilitate deliberate practice without supervision. For educators, new training content, such as patient specific cases can be easily imported to this simulator without any hardware alteration.

A user study was conducted to validate some aspects of this simulator, and demonstrate that training using our simulator resulted in significant skill improvements. To incorporate this simulator into the training curriculum, more rigorous validation is required for future work.