{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T13:15:58Z","timestamp":1777900558053,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gels"],"abstract":"<jats:p>Regional anesthesia is vital for modern surgical practices, but accessibility to training is often hampered by the high cost of commercial phantom models. This study aimed to develop and evaluate low-cost, realistic phantom alternatives using Ecoflex, borax-containing polyvinyl alcohol (PVA), and plastisol compositions. The models were evaluated under ultrasound for imaging properties, including needle visibility, tissue resistance, cost, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), axial full width at half maximum (FWHM), and compared to a commercial reference (Blue Phantom). Initial qualitative assessments were performed by three experienced evaluators, and inter-observer agreement demonstrated good to excellent reliability. In addition, a long-term usability assessment was conducted more than one year after phantom preparation, involving 20 participants using a structured Likert scale. A statistically significant difference was observed among materials (Friedman test, p &lt; 0.05), with PVA hydrogel containing 20 g borax and the Blue Phantom demonstrating the highest tissue realism scores, without a significant difference between them. The results showed that plastisol softener and PVA (20 g borax) hydrogel provided excellent needle visibility and tissue resistance and achieved an imaging performance comparable to the commercial model. Notably, CNR and SNR values for these materials approached reference levels, while costs ranged from $0.5 to $2.50 per 100 mL, representing a significant reduction compared to $45 per 100 mL for commercial models. In conclusion, this research confirms that affordable materials such as PVA and plastisol can effectively simulate human tissue for ultrasound-guided training. Furthermore, the findings suggest that PVA-based hydrogels may provide sustained usability over time, offering a practical and accessible solution for enhancing clinical skill acquisition in resource-constrained settings.<\/jats:p>","DOI":"10.3390\/gels12050388","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:15:27Z","timestamp":1777630527000},"page":"388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Comparative Evaluation of Low-Cost Ultrasound-Guided Regional Anesthesia Phantom Models"],"prefix":"10.3390","volume":"12","author":[{"given":"Melik\u015fah","family":"Soylu","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Aksaray Education and Research Hospital, Aksaray 68200, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Azizo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Mersin University, Mersin 33343, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","unstructured":"Folino, T.B., and Mahboobi, S.K. (2023). Regional anesthetic blocks. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_2","first-page":"705","article-title":"Ultrasound-guided regional anesthesia: Present trends and future directions","volume":"73","author":"Amaral","year":"2023","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2147\/LRA.S236550","article-title":"Benefits and barriers to increasing regional anesthesia in resource-limited settings","volume":"13","author":"Dohlman","year":"2020","journal-title":"Local Reg. Anesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/AAP.0b013e3181d22fe0","article-title":"The ASRA Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia and Pain Medicine","volume":"35","author":"Neal","year":"2010","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_5","first-page":"74","article-title":"Ultrazvuk u regionalnoj anesteziji donjih ekstremiteta-blokovi \u017eivaca i vi\u0161e","volume":"58","year":"2019","journal-title":"Acta Clin. Croat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.procir.2023.03.154","article-title":"Classification of Phantoms for medical imaging","volume":"119","author":"Wegner","year":"2023","journal-title":"Procedia CIRP"},{"key":"ref_7","first-page":"1312","article-title":"Homemade phantoms improve ultrasound-guided vein cannulation confidence and procedural performance on patients","volume":"28","author":"Sabak","year":"2022","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/AAP.0b013e31820d4207","article-title":"A review of the benefits and pitfalls of phantoms in ultrasound-guided regional anesthesia","volume":"36","author":"Hocking","year":"2011","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/AAP.0b013e3181926779","article-title":"The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in Ultrasound-Guided Regional Anesthesia","volume":"34","author":"Sites","year":"2009","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3344\/kjp.2016.29.2.73","article-title":"Ultrasound phantoms to protect patients from novices","volume":"29","author":"Kim","year":"2016","journal-title":"Korean J. Pain"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ultras.2018.03.001","article-title":"Silicone-based composite materials simulate breast tissue to be used as ultrasonography training phantoms","volume":"88","author":"Ustbas","year":"2018","journal-title":"Ultrasonics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/MAT.0000000000001593","article-title":"Fabrication and characterization of tissue-mimicking phantoms for ultrasound-guided cannulation training","volume":"68","author":"Jafary","year":"2022","journal-title":"ASAIO J."},{"key":"ref_13","unstructured":"GTSimulators.com (2024, December 12). Branched 2 Vessel Ultrasound Training Block: Global Tecnologies. Available online: https:\/\/www.gtsimulators.com\/products\/branched-2-vessel-ultrasound-training-block-bpp-101-bpo100?srsltid=AfmBOoozG1-3wSb9O5mXvbKFHubUbHt7Pr7Ull0usARmAVpsq9AOeacy."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.medengphy.2021.08.008","article-title":"A Poly-vinyl Alcohol (PVA)-based phantom and training tool for use in simulated Transrectal Ultrasound (TRUS) guided prostate needle biopsy procedures","volume":"96","author":"Gautam","year":"2021","journal-title":"Med. Eng. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/j.msec.2018.09.028","article-title":"Tissue mimicking materials in image-guided needle-based interventions: A review","volume":"93","author":"Li","year":"2018","journal-title":"Mater. Sci. Eng. C"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hassan, C.M., and Peppas, N.A. (2000). Structure and applications of poly (vinyl alcohol) hydrogels produced by conventional crosslinking or by freezing\/thawing methods. Biopolymers\u00b7PVA Hydrogels, Anionic Polymerisation Nanocomposites, Springer.","DOI":"10.1007\/3-540-46414-X_2"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chatelin, S., Breton, E., Arulrajah, A., Giraudeau, C., Wach, B., Meylheuc, L., and Vappou, J. (2020). Investigation of PolyVinyl Chloride Plastisol Tissue-Mimicking Phantoms for MR- and Ultrasound-Elastography. Front. Phys., 8.","DOI":"10.3389\/fphy.2020.577358"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s11548-023-02911-4","article-title":"Development of an anatomical breast phantom from polyvinyl chloride plastisol with lesions of various shape, elasticity and echogenicity for teaching ultrasound examination","volume":"19","author":"Leonov","year":"2023","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.radi.2024.11.023","article-title":"Fabrication and evaluation of breast tissue equivalent phantoms for image quality assessment in ultrasound imaging","volume":"31","author":"Hariyanto","year":"2024","journal-title":"Radiography"},{"key":"ref_20","first-page":"39","article-title":"Solid heterogeneous phantoms for multimodal ultrasound and diffuse optical imaging: An outcome of the SOLUS project for standardization","volume":"Volume 11075","author":"Cubeddu","year":"2019","journal-title":"Novel Biophotonics Techniques and Applications V"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s10396-021-01178-z","article-title":"Ultrasonography in undergraduate medical education: A comprehensive review and the education program implemented at Jichi Medical University","volume":"49","author":"Kameda","year":"2022","journal-title":"J. Med. Ultrason."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e38813","DOI":"10.1097\/MD.0000000000038813","article-title":"The impact of simulation-based training in medical education: A review","volume":"103","author":"Elendu","year":"2024","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"080903","DOI":"10.1117\/1.JBO.28.8.080903","article-title":"Review of imaging test phantoms","volume":"28","author":"Christie","year":"2023","journal-title":"J. Biomed. Opt."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jmu.2013.08.001","article-title":"A novel phantom for teaching and learning ultrasound-guided needle manipulation","volume":"21","author":"Sultan","year":"2013","journal-title":"J. Med. Ultrasound"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1136\/bmjstel-2018-000370","article-title":"Using clinical simulation to study how to improve quality and safety in healthcare","volume":"6","year":"2020","journal-title":"BMJ Simul. Technol. Enhanc. Learn."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1007\/s00134-012-2597-x","article-title":"International evidence-based recommendations on ultrasound-guided vascular access","volume":"38","author":"Lamperti","year":"2012","journal-title":"Intensiv. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.mpaic.2019.01.017","article-title":"Complications of regional anaesthesia","volume":"20","author":"Taylor","year":"2019","journal-title":"Anaesth. Intensive Care Med."},{"key":"ref_28","first-page":"1","article-title":"Poly (vinyl alcohol) Hydrogels: The Old and New Functional Materials","volume":"2021","author":"Wang","year":"2021","journal-title":"Int. J. Polym. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6796","DOI":"10.1118\/1.4757617","article-title":"Improving the homogeneity of tissue-mimicking cryogel phantoms for medical imaging","volume":"39","author":"Minton","year":"2012","journal-title":"Med. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/AAP.0b013e318269c189","article-title":"The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee Recommendations for Education and Training in Ultrasound-Guided Interventional Pain Procedures","volume":"37","author":"Narouze","year":"2012","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/SIH.0000000000000302","article-title":"Building ultrasound phantoms with modified polyvinyl chloride: A comparison of needle insertion forces and sonographic appearance with commercial and traditional simulation materials","volume":"13","author":"Pepley","year":"2018","journal-title":"Simul. Healthc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"210","DOI":"10.4103\/JMU.JMU_40_18","article-title":"Special ultrasound phantom for interventional training: Construction, advantages, and application","volume":"26","author":"Qurash","year":"2018","journal-title":"J. Med. Ultrasound"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/0019-5049.108558","article-title":"An easily made, low-cost phantom for ultrasound airway exam training and assessment","volume":"57","author":"Schroeder","year":"2013","journal-title":"Indian J. Anaesth."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e70089","DOI":"10.1002\/hkj2.70089","article-title":"Comparison of different phantoms for teaching ultrasound-guided fascia iliaca block\u2014Users survey","volume":"33","author":"Lau","year":"2026","journal-title":"Hong Kong J. Emerg. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"287","DOI":"10.5847\/wjem.j.1920-8642.2017.04.007","article-title":"Procedural simulation: Medical student preference and value of three task trainers for ultrasound guided regional anesthesia","volume":"8","author":"Lahham","year":"2017","journal-title":"World J. Emerg. Med."}],"container-title":["Gels"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2310-2861\/12\/5\/388\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T10:32:52Z","timestamp":1777631572000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2310-2861\/12\/5\/388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":35,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["gels12050388"],"URL":"https:\/\/doi.org\/10.3390\/gels12050388","relation":{},"ISSN":["2310-2861"],"issn-type":[{"value":"2310-2861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}