Article

Simulation in Echocardiography: An Ever-Expanding Frontier

Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Journal of cardiothoracic and vascular anesthesia (Impact Factor: 1.48). 03/2012; 26(3):476-85. DOI: 10.1053/j.jvca.2012.01.019
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    ABSTRACT: OBJECTIVE: To overcome a challenge in transesophageal echocardiographic (TEE) training, an online virtual TEE simulation was developed that allows the user to navigate among the 20 standard views. The TEE probe position and ultrasound plane movements on a 3-dimensional heart model were displayed with the corresponding TEE video recording as the probe was moved among the views. DESIGN: This study evaluated the educational benefit of the virtual TEE application using a pretest/post-test design. SETTING: Single academic teaching hospital. PARTICIPANTS: Ten postgraduate physician volunteers who were novice echocardiographers. INTERVENTIONS: In a controlled environment, 10 study subjects completed a 20 multiple-choice question pretest, used the simulation for 1 hour, and then completed a 20 multiple-choice question post-test. Percentages of correct answers for each test were recorded for each subject. MEASUREMENTS AND MAIN RESULTS: The hypothesis that the median improvement in the number of questions correctly answered was different from 0 was tested with a related-samples Wilcoxon signed-rank test. A p value <0.05 was considered significant. A 1-hour exposure to the virtual TEE simulation produced a significant improvement (p = 0.005) in the post-test score (median 80%) compared with the pretest score (median 20%). CONCLUSIONS: Using the virtual TEE simulation for 1 hour significantly improves the trainees' knowledge of navigation among the 20 standard TEE views. This application freely is available on the Internet and will be a useful adjunct to TEE training programs.
    Journal of cardiothoracic and vascular anesthesia 11/2012; 27(3). DOI:10.1053/j.jvca.2012.09.006 · 1.48 Impact Factor
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    ABSTRACT: BACKGROUND: Congenital heart diseases (CHD) are responsible for substantial morbidity and mortality in neonates. The preliminary diagnosis often is made by noncardiologists. For this reason, there is a huge demand of training in echocardiography of CHD. This is difficult to achieve due to limited resources of specialized centers. OBJECTIVE: The goal of this study was to investigate the training effect of the echocardiography simulator EchoCom on trainee's ability to diagnose CHD. DESIGN/METHODS: We enrolled 10 residents for simulator-based training in echocardiography of CHD. All participants were instructed on the simulator's basic handling and had one hour to scan the first 9 datasets information (ventricular septal defect, atrial septal defect, atrioventricular septal defect, Tetralogy of Fallot, transposition of great arteries, congenital corrected transposition of great arteries, common arterial trunk, hypoplastic left heart syndrome, normal anatomy) and establish a diagnosis. No help was given except for support regarding simulator related issues. Afterward, 2 rounds of structured simulator based echocardiography training focused on echocardiographic anatomy, spatial orientation, standard views, and echocardiographic anatomy of different CHD followed. All participants completed a standardized questionnaire containing 10 multiple-choice (MC) questions focusing on basic theoretical knowledge in echocardiographic anatomy and common CHD. RESULTS: Almost all of the residents invited from the affiliated children's hospital had little (20%) or no experience (80%) in echocardiography of CHD. Their Pretest and Posttest scores showed significant improvement for both, MC test and performance test, respectively. CONCLUSIONS: Our study showed that simulator-based training in echocardiography in CHD could be very effective and may assist with training outside the scope of CHD.
    Echocardiography 01/2013; 30(6). DOI:10.1111/echo.12118 · 1.25 Impact Factor
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    ABSTRACT: Simulators are a new tool in education in many fields, including medicine, where they greatly improve familiarity with medical procedures, reduce costs, and, importantly, cause no harm to patients. This is so in the case of transesophageal echocardiography, in which the use of a simulator facilitates spatial orientation and helps in case studies. The aim of the project described in this article is to simulate an examination by transesophageal echocardiography. This research makes use of available computed tomography data to simulate the corresponding echocardiographic view. The article describes the essential characteristics that distinguish these two modalities and the key principles of the wave phenomena that should be considered in the simulation process, taking into account the conditions specific to the echocardiography. The construction of the CT2TEE (Web-based transesophageal echocardiography simulator) is also presented. The considerations include ray-tracing and ray-casting techniques in the context of ultrasound beam and artifact simulation. An important aspect of the interaction with the user is raised.
    IEEE transactions on bio-medical engineering 02/2013; 60(2):292-299. DOI:10.1109/TBME.2012.2226212 · 2.23 Impact Factor
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